Malignant multiple sclerosis: clinical and demographic prognostic factors

Abstract

Patients with malignant multiple sclerosis (MMS) reach a significant level of disability within a short period of time (Expanded Disability Status Scale score of 6 within five years). The clinical profile and progression of the disease were analyzed in a Brazilian cohort of 293 patients. Twenty-five (8,53%) patients were found to have MMS and were compared with the remaining 268 (91,47%). Women, non-white patients, older age at disease onset, shorter intervals between the first attacks, and more attacks in the first two years of the disease were all more common in the MMS group. These findings could serve as prognostic factors when making therapeutic decisions.

Autologous haematopoietic stem cell transplantation as a first-line disease-modifying therapy in patients with ‘aggressive’ multiple sclerosis

“…A total of 20 patients with 'aggressive' MS who received AHSCT as a first-line DMT were identified from five centres ( Table 1). There was an equal proportion of male and female with a median age of 28 (17-47) years at diagnosis and a median interval of 5 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) months between diagnosis and treatment. The median last EDSS score before transplant was 5 (1.5-9.5).…”

“…These patients do not respond adequately to first-line disease-modifying therapies (DMTs) and should therefore be treated early with one of the higher efficacy DMTs, although a high proportion of them do not respond optimally to these agents. [11][12][13][14][15][16] Autologous haematopoietic stem cell transplantation (AHSCT) has gained considerable interest in recent years as an efficacious therapy for a selected group of patients with MS who have clinically and radiologically active disease, despite the use of standard DMTs. 17 Treatment-related mortality has reduced significantly in the last two decades through better patient selection, optimisation of transplant technique and increased centre experience.…”

“…These patients do not respond adequately to first-line disease-modifying therapies (DMTs) and should therefore be treated early with one of the higher efficacy DMTs, although a high proportion of them do not respond optimally to these agents. 11 – 16 …”

Predictive factors and treatment challenges in malignant progression of relapsing-remitting multiple sclerosis

“…Therefore, to ensure greater caution and validity in our findings, we only considered patients with an EDSS score of 1 or less after at least 10 years of disease onset as having benign MS.). Malignant MS: Refers to patients who have MS within the last 5 years and have an EDSS score of 6 or higher [ [21] , [22] , [23] ]. MS MRI plaques: MS MRI plaque is a visible area of damage or inflammation on the brain or spinal cord MRI caused by an abnormal immune response that targets and damages the myelin.…”

“…Malignant MS: Refers to patients who have MS within the last 5 years and have an EDSS score of 6 or higher [ [21] , [22] , [23] ].…”