免疫消融和自体造血干细胞移植对多发性硬化症脑灰质和白质萎缩的影响。
Impact of immunoablation and autologous hematopoietic stem cell transplantation on gray and white matter atrophy in multiple sclerosis.
机构信息
McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada/Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
出版信息
Mult Scler. 2018 Jul;24(8):1055-1066. doi: 10.1177/1352458517715811. Epub 2017 Jun 15.
BACKGROUND
Immunoablation and autologous hematopoietic stem cell transplantation (IA/aHSCT) halts relapses, white matter (WM) lesion formation, and pathological whole-brain (WB) atrophy in multiple sclerosis (MS) patients. Whether the latter was due to effects on gray matter (GM) or WM warranted further exploration.
OBJECTIVE
To model GM and WM volume changes after IA/aHSCT to further understand the effects seen on WB atrophy.
METHODS
GM and WM volume changes were calculated from serial baseline and follow-up magnetic resonance imaging (MRI) ranging from 1.5 to 10.5 years in 19 MS patients treated with IA/aHSCT. A mixed-effects model with two predictors (total busulfan dose and baseline T1-weighted WM lesion volume "T1LV") characterized the time-courses after IA/aHSCT.
RESULTS
Accelerated short-term atrophy of 2.1% and 3.2% occurred in GM and WM, respectively, on average. Both busulfan dose and T1LV were significant predictors of WM atrophy, whereas only busulfan was a significant predictor of GM atrophy. Compared to baseline, a significant reduction in GM atrophy, not WM atrophy, was found. The average rates of long-term GM and WM atrophy were -0.18%/year (standard error (SE): 0.083) and -0.07%/year (SE: 0.14), respectively.
CONCLUSION
Chemotherapy-related toxicity affected both GM and WM. WM was further affected by focal T1-weighted lesion-related pathologies. Long-term rates of GM and WM atrophy were comparable to those of normal-aging.
背景
免疫消融和自体造血干细胞移植（IA/aHSCT）可阻止多发性硬化症（MS）患者的复发、白质（WM）病变形成和全脑（WB）病理性萎缩。后者是否因对灰质（GM）或 WM 的影响而需要进一步探讨。
目的
对 IA/aHSCT 后 GM 和 WM 体积变化进行建模，以进一步了解对 WB 萎缩的影响。
方法
对 19 例接受 IA/aHSCT 治疗的 MS 患者的基线和随访磁共振成像（MRI）进行分析，时间范围从 1.5 年到 10.5 年。采用具有两个预测因子（总白消安剂量和基线 T1 加权 WM 病变体积“T1LV”）的混合效应模型来描述 IA/aHSCT 后的时间过程。
结果
GM 和 WM 的平均短期萎缩率分别为 2.1%和 3.2%。白消安剂量和 T1LV 均为 WM 萎缩的显著预测因子，而仅白消安是 GM 萎缩的显著预测因子。与基线相比，GM 萎缩明显减少，但 WM 萎缩不明显。GM 和 WM 的长期平均萎缩率分别为-0.18%/年（标准误差（SE）：0.083）和-0.07%/年（SE：0.14）。
结论
化疗相关毒性影响 GM 和 WM。WM 进一步受到局灶性 T1 加权病变相关病理的影响。GM 和 WM 的长期萎缩率与正常衰老相当。
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