The consequences of delayed diagnosis and treatment in persons with multiple sclerosis given autologous hematopoietic stem cell transplantation
Author:
Pastelín-Martínez María de Lourdes12, Gallardo-Pérez Moisés Manuel13, Gómez-de-León Andrés4, Olivares-Gazca Juan Carlos13, Hernández-Flores Edgar Jared13, Sánchez-Bonilla Daniela13, Montes-Robles Merittzel12, Robles-Nasta Max13, Ocaña-Ramm Guillermo13, Soto-Olvera Silvia35, Gómez-Almaguer David4, Ruiz-Delgado Guillermo J.13, Ruiz-Argüelles Guillermo J.13ORCID
Affiliation:
1. Centro de Hematología y Medicina Interna de Puebla , Puebla , México 2. Universidad Anáhuac de Puebla , Puebla , México 3. Universidad Popular Autónoma del Estado de Puebla , Puebla , México 4. Hospital Universitario de Nuevo León , Monterrey , México 5. Laboratorios RUIZ , SYNLAB , Puebla , México
Abstract
Abstract
Objectives
We have analyzed the association of delayed both diagnosis and treatment of persons with MS with the long-term results of patients given aHSCT.
Methods
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 8 months (delayed diagnosis, DD), or less than 8 months (non-delayed diagnosis, NDD). The progression of MS was assessed by changes in the expanded disability status scale (EDSS).
Results
The time elapsed between the onset of symptoms and the correct diagnosis was lower for the NDD group (1.55 vs. 35.87 months, 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 in the DD group (4.5 vs. 3.0, p=0.3) and the response of the EDSS score to the transplant 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.
Conclusions
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 an early aHSCT intervention are critical for a good prognosis, in terms of lowering and stabilizing the motor disability in MS patients given autografts.
Publisher
Walter de Gruyter GmbH
Subject
Biochemistry (medical),Clinical Biochemistry,Public Health, Environmental and Occupational Health,Health Policy,Medicine (miscellaneous)
Reference31 articles.
1. Walton, C, King, R, Rechtman, L, Kaye, W, Leray, E, Marrie, RA, et al.. Rising prevalence of multiple sclerosis worldwide: insights from the Atlas of MS, third edition. Mult Scler 2020;26:1816–21. https://doi.org/10.1177/1352458520970841. 2. Cárdenas-Robledo, S, Lopez-Reyes, L, Arenas-Vargas, LE, Carvajal-Parra, MS, Guío-Sánchez, C. Delayed diagnosis of multiple sclerosis in a low prevalence country. Neurol Res 2021;43:521–7. https://doi.org/10.1080/01616412.2020.1866374. 3. Thompson, AJ, Banwell, BL, Barkhof, F, Carroll, WM, Coetzee, T, Comi, G, et al.. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2018;17::162–73. 4. Moghaddam, VK, Dickerson, AS, Bazrafshan, E, Seyedhasani, SN, Najafi, F, Hadei, M, et al.. Socioeconomic determinants of global distribution of multiple sclerosis: an ecological investigation based on global burden of disease data. BMC Neurol 2021;21:145. https://doi.org/10.1186/s12883-021-02170-3. 5. Patti, F, Chisari, CG, Arena, S, Toscano, S, Finocchiaro, C, FermoLo, S, et al.. Factors driving delayed time to multiple sclerosis diagnosis: results from a population-based study. Mult Scler Relat Disord 2022;57:103361. https://doi.org/10.1016/j.msard.2021.103361.
|
|