HSCT and cognition

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Is Hematopoietic Stem Cell Transplantation aka HSCT the panacea that it seems. A cure all, or simply the trap of a success story? HSCT is able to stop inflammation or reduce it significantly for long periods of time. It has been shown to have positive effects on mobility and fatigue.

Recently, in a single centre study, investigators also report an improvement in cognition; namely information processing and verbal learning after 12 months post-treatment. A more detailed abstract of the findings is below.

A note of caution, however, there was a trend to decline in cognition at the initial 3 month mark; most likely reflecting the neurotoxicity of the conditioning regimen.

Other drawbacks are that the study is small and only goes ahead as far as 24 months – this is small in terms of brain volume changes in MS. And depending on the cognitive test performed, the investigators also noted different outcomes – there was definitely plateauing of improvement after 12 months, or in the case of the BICAMS score no observed change at all.

Therefore, more follow up is needed in larger numbers to really evaluate the changes that are taking place and its sustainability in the long-term.

Abstract

Sci Rep. 2020 Dec 4;10(1):21286. doi: 10.1038/s41598-020-78160-1.

Selective cognitive dysfunction and physical disability improvement after autologous hematopoietic stem cell transplantation in highly active multiple sclerosis

N GiedraitieneR Kizlaitiene V Peceliunas L Griskevicius G Kaubrys

The aim was to assess the cognitive dysfunction and physical disability after autologous hematopoietic stem cell transplantation (AHSCT), to explore the potential factors influencing disability regression after AHSCT and to estimate the safety of low-dose immunosuppressive therapy in highly active Multiple Sclerosis (MS) patients. In single-center prospective study patients who failed to conventional therapies for highly active relapsing MS underwent the AHSCT. The disability was followed up with Expanded Disability Status Scale and cognition with Brief International Cognitive Assessment for Multiple Sclerosis. Twenty four patients [18 (72.0%) female] underwent AHSCT. Two patients of 13 had one relapse during the first year and three patients-during the second year after AHSCT. Disability regression was found in 84.6% of patients. The scores of information processing speed and verbal learning were significantly higher at month 12 after AHSCT. The clinical variable that explained the disability regression at months 6 and 12 after AHSCT was the disability progression over 6 months before AHSCT. No transplant related-deaths were observed. Selective cognitive improvement was found after AHSCT in MS patients. The disability may be temporarily reversible after AHSCT in a significant proportion of highly active RMS patients if AHSCT is well-timed performed.

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Neuro Doc Gnanapavan

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