Favorable evolution post hematologous stem cell transplant after Primary central nervous system lymphoma in a Multiple Sclerosis under Natalizumab
ECTRIMS Online Library. Fromont A. 10/25/17; 199780; EP1760
Agnès Fromont
Agnès Fromont

Abstract: EP1760

Type: ePoster

Abstract Category: Therapy - disease modifying - 29 Risk management for disease modifying treatments

The association between Primary central nervous system lymphoma (PCNSL) and Multiple Sclerosis (MS) treated with natalizumab (N) can be a coincidence. This case is the sixth known. 150 000 MS are treated with N through the world in 2016. The prevalence of PCNSL is 3.3 cases for 100 000 MS treated with N. This number is higher than PCNSL in the general population (1.8 to 3 for 100 000 person).
To report a new case of PCNSL in MS under N treated with hematologous stem cell transplant (HSCT).
Case report: A MS was diagnosed in 1997 in a man born in 1970. After interferon beta-1b, N was started in November 2000. The Expanded Disability Status Scale (EDSS) was 3.0. In June 2011, he was hospitalized because of loss of weight, depression, cognitive impairment and headache. Neurological exam revealed psychomotor slackening, instable walking requiring a crutch (EDSS 6.0). Brain MRI showed several flair hypersignals involving right internal capsule with mass effect on ventricle, corpus callosum and left insula, all enhanced. Standard biological exams, Lymphocytes T, B, blood immunofixation were normal. Serologies were negative except for EBV. Because of the mass effect, lumbar puncture was not done. Bone biopsy, thoraco abdomino pelvic CT scan were normal. The brain biopsy revealed PCNSL type B. In October 2011 he underwent HSCT. In February 2012 he was considered in remission. In May 2012 his walk was to 500 meters. Important asthenia persisted with hyperemotivity. At last visit, patient was stable without MS treatment (EDSS 4.0).
In this case, HSCT allowed not only PCNSL remission but also MS remission. HSCT has been proposed to control or even cure refractory cases of MS for several years. This transplant leads reset the pathogenic T cells repertoire thus renewing the immune system repertoire and possibly reinforcing immune tolerance mechanism.
Fromont: nothing to disclose
Casasnovas: nothing to disclose
Billy: nothing to disclose
Martin: nothing to disclose
Moreau: nothing to disclose

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