Contributions
Abstract: EP1308
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - MS Variants
Introduction: Autologous hematopoietic stem cell transplantation (ASCT) is a treatment used in patients with Neuromyelitis Optica (NMO) refractory to conventional pharmacologicaltherapies but often guarantees only a temporary control of the disease.Tocilizumab, an interleukin 6 receptor-blocking antibody, can be effective in therapy-resistant cases of NMO, but its role, after ASCT, has not yet been well investigated.
Aims: We present a case of NMO patient showingdisease activity after ASCT, which was managed by tocilizumab administration.
Methods: A 29-year-old woman developed a disseminated demyelinating disease with encephalic and optic nerve lesions, and a longitudinally extensive myelitis on MRI (Expanded Disability Status Scale [EDSS] score: 2.0).Mitoxantrone was administrated for four cycles and a six-year period of clinical and radiological stability was obtained (EDSS:1.0). Subsequently, the patient developed a bilateral optic neuritis; serum anti-aquaporin 4 antibody testing was positive anda diagnosis of NMO according to established criteriawas formulated. In the following two years, she developed new relapses which resulted in a dramatic worsening of her clinical condition and an increased lesion burden on spinal MRI with the presence of gadolinium-enhancing T1 lesions(EDSS: 5.5).Oral steroids, plasmapheresis, azathioprine and rituximab failed to control the disease. ASCT was performed obtaining a progressive decrease in the EDSS score (EDSS:2.5).
Results: 9 months after transplantation, patient showed a relapseanddisability progression, with only a partial recovery after i.v. methylprednisolone administration and a cycle of plasmapheresis(EDSS: 3.5). Due to the poor response to the previous medical treatments, therapy with tocilizumab was initiated at a dose of 8 mg/kg every 4 weeks. After a follow-up of more than 12 months, no relapses, MRI activity, or adverse events occurred.
Conclusions: Tocilizumab could represent a promising and safe treatment in patients with aggressive NMO who have failed ASCT.
Disclosure: Dr. De Rossi received speaker honoraria from Biogen and Teva and travel grants from Biogen, Teva and Merk Serono. Dr. Capra received consulting fees from Novartis, Biogen-Idec and lecture fees and/or travel grants from Novartis, Biogen-Idec, Teva, Genzyme and Sanofi-Aventis. Dr. Scarpazza and Dr. Mancinelli have nothing to disclose
Abstract: EP1308
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - MS Variants
Introduction: Autologous hematopoietic stem cell transplantation (ASCT) is a treatment used in patients with Neuromyelitis Optica (NMO) refractory to conventional pharmacologicaltherapies but often guarantees only a temporary control of the disease.Tocilizumab, an interleukin 6 receptor-blocking antibody, can be effective in therapy-resistant cases of NMO, but its role, after ASCT, has not yet been well investigated.
Aims: We present a case of NMO patient showingdisease activity after ASCT, which was managed by tocilizumab administration.
Methods: A 29-year-old woman developed a disseminated demyelinating disease with encephalic and optic nerve lesions, and a longitudinally extensive myelitis on MRI (Expanded Disability Status Scale [EDSS] score: 2.0).Mitoxantrone was administrated for four cycles and a six-year period of clinical and radiological stability was obtained (EDSS:1.0). Subsequently, the patient developed a bilateral optic neuritis; serum anti-aquaporin 4 antibody testing was positive anda diagnosis of NMO according to established criteriawas formulated. In the following two years, she developed new relapses which resulted in a dramatic worsening of her clinical condition and an increased lesion burden on spinal MRI with the presence of gadolinium-enhancing T1 lesions(EDSS: 5.5).Oral steroids, plasmapheresis, azathioprine and rituximab failed to control the disease. ASCT was performed obtaining a progressive decrease in the EDSS score (EDSS:2.5).
Results: 9 months after transplantation, patient showed a relapseanddisability progression, with only a partial recovery after i.v. methylprednisolone administration and a cycle of plasmapheresis(EDSS: 3.5). Due to the poor response to the previous medical treatments, therapy with tocilizumab was initiated at a dose of 8 mg/kg every 4 weeks. After a follow-up of more than 12 months, no relapses, MRI activity, or adverse events occurred.
Conclusions: Tocilizumab could represent a promising and safe treatment in patients with aggressive NMO who have failed ASCT.
Disclosure: Dr. De Rossi received speaker honoraria from Biogen and Teva and travel grants from Biogen, Teva and Merk Serono. Dr. Capra received consulting fees from Novartis, Biogen-Idec and lecture fees and/or travel grants from Novartis, Biogen-Idec, Teva, Genzyme and Sanofi-Aventis. Dr. Scarpazza and Dr. Mancinelli have nothing to disclose