Saturday, 17 November 2018

How does HSCT work?

I have been asking myself about the non-myeablative HSCT and wondering how does it work?

It is often a combination of cyclophophamide and anti-thymocyte globulin.

Friday, 16 November 2018

Alternatives to Cladribine tablets appears

DrK has been beavering away and has now started to disclose his experience

Thursday, 15 November 2018

HSCT after natalizumab

Mariottini A, Innocenti C, Forci B, Magnani E, Mechi C, Barilaro A, Nistri R, Fani A, Saccardi R, Massacesi L, Repice AM. Safety and efficacy of autologous hematopoietic stem cell transplantation following natalizumab discontinuation in aggressive Multiple Sclerosis. Eur J Neurol. 2018 Nov 10. doi: 10.1111/ene.13866. [Epub ahead of print]

BACKGROUND: Natalizumab (NTZ) is a highly effective treatment for relapsing-remitting multiple sclerosis (RRMS), but its withdrawal is often followed by disease reactivation or rebound, even if other disease-modifying treatments (DMTs) are administered. In this study, for the first time, safety and efficacy of autologous hematopoietic stem cell transplantation (aHSCT) performed following NTZ discontinuation was retrospectively compared with conventional DMTs.
METHODS: Patients with RRMS treated with NTZ and who discontinued the drug after at least six administrations and with at least six months of follow-up were included. Patients underwent aHSCT after a minimum period of six months following NTZ withdrawal, receiving in the meanwhile cyclophosphamide or corticosteroids, or received other DMTs approved for MS (control group) after an adequate wash-out period. Both haematological and neurological follow-up were assessed according to standard policies.
RESULTS: Fifty-two patients were included, 11 who received aHSCT and 41 DMTs. Baseline clinical and demographic characteristics were similar between the two groups. No fatality or life-threatening complications, including Progressive Multifocal Leukoencephalopathy, were observed. At three years following NTZ discontinuation no evidence of disease activity was reported in 54.5% of the patients in the aHSCT group compared to 11.5% of those in the DMT group (p=0.0212); disease reactivation in the aHSCT patients was observed only during wash-out/bridging therapy and after aHSCT 100% of the cases were free from disease activity.
CONCLUSION: These data suggest that an aggressive therapy should be established after NTZ with the shortest possible wash-out period. AHSCT after six months from NTZ withdrawal seems safe.

If you are not having a sub clinical infection of JC virus, conversion to a depleting antibody is safe. However there have been cases of fatality after alemtuzumab, where there was carry over infection. So the risks for HSCT are similar so ensure you don't have sub clinical PML before starting

Guest post: digital services for MSers

As we all are aware, there is an increasing number of organisations developing and providing digital services to help make life easier for people with MS.

Wednesday, 14 November 2018

Reminder about the free, one-day event for ‘plus ones’ of people recently diagnosed with MS

One week on Saturday we are involved in an information event for partners, family and friends of people newly diagnosed with MS - come along if you're in London!

Tuesday, 13 November 2018

Small gains, upper limb robotics

Front Neurol. 2018 Oct 24;9:905. doi: 10.3389/fneur.2018.00905. eCollection 2018.

Effects of High-intensity Robot-assisted Hand Training on Upper Limb Recovery and Muscle Activity in Individuals With Multiple Sclerosis: A Randomized, Controlled, Single-Blinded Trial.

Sunday, 11 November 2018

Alemtuzumab it isn't just problems with B cell Autoimmunities.

Alemtzumab induces CD8 mediated autoimmunity. 

Is it Shock, Horror, Probe! or time for more reading on how T cells
repopulate after depletion

Saturday, 10 November 2018

What should you expect to Save your Brain

The great and the good have got together to try and come to come to a consensus of what you should expect with regard to

Time for referral and diagnosis. 
Time to treatment decisions 
How you should be monitored 
How quick should you report issues 
How quick should the response be.

The finger is pointing to the B cell with disease reactivation

This is a case report.

Is it a fluke or does it tell us something

Friday, 9 November 2018

I don't usually do Cure of the Week but

I don't usually do "Cure of the Week", where someone treats a mouse and it somehow becomes the next great hope for MS. 

DrK sparked my interest by a twitter post