The consequences of delayed diagnosis and treatment in persons with multiple sclerosis given autologous hematopoietic stem cell transplantation.

Abstract

We have analyzed the association of delayed both diagnosis and treatment of persons with MS with the long-term results of patients given autologous hematopoietic stem cell transplantation (aHSCT). Patients with MS referred to the HSCT-Mexico program were included in the study; in 103, detailed pre- and post-transplant evolution could be recorded. Two groups of patients were analyzed according to the time of evolution between the onset of symptoms and the definite diagnosis of MS: more than 8months (delayed diagnosis, DD), or less than 8months (non-delayed diagnosis, NDD). The progression ofMS was assessed by changes in the expanded disability status scale (EDSS). The time elapsed between the onset of symptoms and the correct diagnosis was lower for the NDD group (1.55vs. 35.87months, p<0.05). Both groups of patients showed a similar EDSS score at diagnosis (1.5 vs. 1.5); however, the EDSS at the time of the transplant was higher inthe DD group (4.5 vs. 3.0, p=0.3) and the response of the EDSS score to thetransplant was significantly better for the NDD group, the last EDSS scores being 2.5 vs. 4.25 (p=0.03). Both groups of patients responded to aHSCT by diminishing the EDSS, but the response was significantly better in the NDD group. These data indicate that both the pre-transplant progression of the disease and the response to aHSCT were significantly worse in the DD group. An early diagnosis and anearly aHSCT intervention are critical for a good prognosis, interms of lowering and stabilizing the motor disability in MSpatients given autografts.