Autologous hematopoietic stem cell transplantation improves fatigue in multiple sclerosis. (November 2019)

• Record Type: Journal Article
• Authors: Bose, Gauruv; Atkins, Harold L; Bowman, Marjorie; Freedman, Mark S
• Is Part Of: Multiple sclerosis. Volume 25:Number 13(2019)
• Page Start: 1764
• Page End: 1772
• Publication Date: 2019-11
• Subjects: Multiple sclerosis -- hematopoietic stem cell transplantation -- fatigue -- quality of life -- neurology -- haematology; Central nervous system -- Diseases -- Periodicals; Myelin sheath -- Diseases -- Periodicals; Inflammation -- Periodicals; Multiple sclerosis -- Periodicals; Central Nervous System Diseases -- Periodicals; Demyelinating Diseases -- Periodicals; Inflammation -- Periodicals; Multiple Sclerosis -- Periodicals; Système nerveux central -- Maladies -- Périodiques; Gaine de myéline -- Maladies -- Périodiques; Inflammation (Pathologie) -- Périodiques; Sclérose en plaques -- Périodiques; Electronic journals; 616.834005
• DOI: 10.1177/1352458518802544
• Languages: English
• ISSNs: 1352-4585

Abstract

Background: Fatigue is a common problem in multiple sclerosis (MS) affecting as many as 90% of patients. The Fatigue Impact Scale (FIS) is a validated measure of fatigue in MS patients. The cause of fatigue in MS is likely multifactorial, with some evidence that ongoing central nervous system (CNS) inflammation is a contributing factor. Immunoablation and autologous hematopoietic stem cell transplantation (aHSCT) have been shown to halt ongoing CNS inflammation. Objective: To investigate whether halting all ongoing inflammation with aHSCT impacts FIS scores in patients with severe MS. Methods: In the Canadian aHSCT study (ClinicalTrials.gov, NCT01099930), 23 patients underwent aHSCT and had FIS prospectively collected every 6 months for 36 months of follow-up. Change in FIS was analysed by repeated-measures analysis of variance (RMANOVA) with multiple linear regression to determine independent predictors. Results: The median FIS score decreased 36%, from 36 to 23 ( p = 0.001), and four patients had 100% reduction. Improvement in FIS correlated with lower age and Expanded Disability Status Scale at baseline, as well as increased independence as evidenced by a return to gainful employment and even driving. Conclusion: Patients had significantly less fatigue on average after aHSCT. This may serve to better understand the contribution of ongoing CNS inflammation to fatigue peculiar to MS.