. 2023 Mar 14;100(11):e1109-e1122.

doi: 10.1212/WNL.0000000000206750. Epub 2022 Dec 21.

Hematopoietic Stem Cell Transplantation in People With Active Secondary Progressive Multiple Sclerosis

Giacomo Boffa¹, Alessio Signori¹, Luca Massacesi¹, Alice Mariottini¹, Elvira Sbragia¹, Salvatore Cottone¹, Maria Pia Amato¹, Claudio Gasperini¹, Lucia Moiola¹, Stefano Meletti¹, Anna Maria Repice¹, Vincenzo Brescia Morra¹, Giuseppe Salemi¹, Francesco Patti¹, Massimo Filippi¹, Giovanna De Luca¹, Giacomo Lus¹, Mauro Zaffaroni¹, Patrizia Sola¹, Antonella Conte¹, Riccardo Nistri¹, Umberto Aguglia¹, Franco Granella¹, Simonetta Galgani¹, Luisa Maria Caniatti¹, Alessandra Lugaresi¹, Silvia Romano¹, Pietro Iaffaldano¹, Eleonora Cocco¹, Riccardo Saccardi¹, Emanuele Angelucci¹, Maria Trojano¹, Giovanni Luigi Mancardi¹, Maria Pia Sormani¹, Matilde Inglese²; Italian BMT-MS Study Group and the Italian MS Register

Collaborators, Affiliations

Collaborators

Italian BMT-MS Study Group and the Italian MS Register:
Marco Capobianco, Giovanni Bosco Zimatore, Jessica Frau, Elio Scarpini, Giuseppe Meucci, Donata Guidetti, Francesca Gualandi, Riccardo Varaldo, Anna Maria Raiola, Chiara Innocenti, Valerio Zoli, Fabio Ciceri, Raffaella Greco, Rosanna Scimè, Marco De Gobbi, Alessandro Barilaro

Affiliations

¹ From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy.
² From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy. m.inglese@unige.it.

PMID: 36543569
PMCID: PMC10074454
DOI: 10.1212/WNL.0000000000206750

Hematopoietic Stem Cell Transplantation in People With Active Secondary Progressive Multiple Sclerosis

Giacomo Boffa et al. Neurology. 2023.

. 2023 Mar 14;100(11):e1109-e1122.

doi: 10.1212/WNL.0000000000206750. Epub 2022 Dec 21.

Authors

Collaborators

Italian BMT-MS Study Group and the Italian MS Register:
Marco Capobianco, Giovanni Bosco Zimatore, Jessica Frau, Elio Scarpini, Giuseppe Meucci, Donata Guidetti, Francesca Gualandi, Riccardo Varaldo, Anna Maria Raiola, Chiara Innocenti, Valerio Zoli, Fabio Ciceri, Raffaella Greco, Rosanna Scimè, Marco De Gobbi, Alessandro Barilaro

Affiliations

¹ From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy.
² From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy. m.inglese@unige.it.

PMID: 36543569
PMCID: PMC10074454
DOI: 10.1212/WNL.0000000000206750

Abstract

Background and objectives: Uncontrolled evidence suggests that autologous hematopoietic stem cell transplantation (AHSCT) can be effective in people with active secondary progressive multiple sclerosis (SPMS). In this study, we compared the effect of AHSCT with that of other anti-inflammatory disease-modifying therapies (DMTs) on long-term disability worsening in active SPMS.

Methods: We collected data from the Italian Bone Marrow Transplantation Study Group and the Italian Multiple Sclerosis Register. Patients were considered eligible if treatment had been started after the diagnosis of SPMS. Disability worsening was assessed by the cumulative proportion of patients with a 6-month confirmed disability progression (CDP) according to the Expanded Disability Status Scale (EDSS) score. Key secondary endpoints were the EDSS time trend after treatment start and the prevalence of disability improvement over time. Time to first CDP was assessed by means of proportional hazard Cox regression models. A linear mixed model with a time × treatment group interaction was used to assess the longitudinal EDSS time trends. Prevalence of improvement was estimated using a modified Kaplan-Meier estimator and compared between groups by bootstrapping the area under the curve.

Results: Seventy-nine AHSCT-treated patients and 1975 patients treated with other DMTs (beta interferons, azathioprine, glatiramer-acetate, mitoxantrone, fingolimod, natalizumab, methotrexate, teriflunomide, cyclophosphamide, dimethyl fumarate, and alemtuzumab) were matched to reduce treatment selection bias using propensity score and overlap weighting approaches. Time to first CDP was significantly longer in transplanted patients (hazard ratio [HR] = 0.50; 95% CI = 0.31-0.81; p = 0.005), with 61.7% of transplanted patients free from CPD at 5 years. Accordingly, EDSS time trend over 10 years was higher in patients treated with other DMTs than in AHSCT-treated patients (+0.157 EDSS points per year compared with -0.013 EDSS points per year; interaction p < 0.001). Patients who underwent AHSCT were more likely to experience a sustained disability improvement: 34.7% of patients maintained an improvement (a lower EDSS than baseline) 3 years after transplant vs 4.6% of patients treated by other DMTs (p < 0.001).

Discussion: The use of AHSCT in people with active SPMS is associated with a slowing of disability progression and a higher likelihood of disability improvement compared with standard immunotherapy.

Classification of evidence: This study provides Class III evidence that autologous hematopoietic stem cell transplants prolonged the time to CDP compared with other DMTs.

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Conflict of interest statement

G. Boffa was supported by a research fellowship FISM - Fondazione Italiana Sclerosi Multipla 2019/BR/016 and financed or cofinanced with the “5 per mille” public funding. A. Signori has nothing to disclose. L. Massacesi received educational grants and/or research funds from Fondazione Cassa di Risparmio di Firenze, Biogen, Merck-Serono, Genzyme, and Roche and received honoraria or consultation fees from Biogen, Roche, Mylan, Merck-Serono, Genzyme, and Novartis. A. Mariottini reports nonfinancial support from Biogen idec, Sanofi Genzyme, Novartis, Teva, and Roche and personal fees from Merck Serono. E. Sbragia has nothing to disclose. S. Cottone received grants and honoraria from Roche, Sanofi, Merck, Biogen, and Novartis. M.P. Amato has served on Scientific Advisory Boards for Biogen, Novartis, Roche, Merck, Sanofi Genzyme, and Teva; received speaker honoraria from Biogen, Merck, Sanofi Genzyme, Roche, Novartis, and Teva; and received research grants for her Institution from Biogen, Merck, Sanofi Genzyme, Novartis, and Roche. C. Gasperini reports fees as invited speaker or travel expenses for attending meeting from Biogen, Merck‐Serono, Teva, Mylan, Sanofi, Novartis, and Genzyme. LP: consulting fees from Biogen, Novartis, and Roche; speaker honoraria from Biogen, Genzyme, Merck Serono, Mylan, Novartis, and Teva; travel grants from Biogen, Genzyme, Novartis, and Teva; and research grants from the Italian MS Society (Associazione Italiana Sclerosi Multipla) and Genzyme. L. Moiola has received speaker's honoraria from the following companies: Biogen, Merck, Novartis, Roche, Sanofi-Genzyme, and TEVA. S. Meletti has nothing to disclose. V. Brescia Morra has received funding for research support and speaker honoraria from Novartis, Roche, Biogen, Teva, Almirall, Sanofi-Genzyme, Merk, Bayer, and Mylan. M. Trojano has served on scientific AB for Biogen, Novartis, Roche, Merck, and Genzyme; received speaker honoraria from Biogen, Roche, Sanofi, Merck, Genzyme, and Novartis; and received research grants for her Institution from Biogen, Merck, and Novartis. G. Salemi received grants and honoraria from Roche, Sanofi, Merck, Biogen, and Novartis. F. Patti reports consulting fees from Alexion, Almirall, Bayer, Biogen, Calgene, Merck, Myalin, Novartis, Roche, Sanofi, and TEVA and research grants from Biogen and Merck. M. Filippi is Editor-in-Chief of the Journal of Neurology and Associate Editor of Human Brain Mapping, received compensation for consulting services and/or speaking activities from Almiral, Alexion, Bayer, Biogen, Celgene, Eli Lilly, Genzyme, Merck-Serono, Novartis, Roche, Sanofi, Takeda, and Teva Pharmaceutical Industries, and receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, Teva Pharmaceutical Industries, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA). G. De Luca reports travel grants and/or speaker honoraria from Merck-Serono, Roche, Sanofi Genzyme, and Biogen. G. Lus has nothing to disclose. M. Zaffaroni received travel support and fees for lecturing or participating in advisory boards from Almirall, Biogen, Merck, Novartis, and Sanofi-Genzyme. P. Sola received travel grants from Teva, Roche, Sanofi, Merck, Biogen, Bristol, and Novartis and fees for consultation from Merck, Biogen, and Sanofi Genzyme. A. Conte received grants from Roche and fees for consultation from Sanofi Genzyme, Merck, Biogen, Almirall, and Novartis. R. Nistri has nothing to disclose. U. Aguglia has nothing to disclose. F. Granella received research grants from Biogen and Roche and fees for consultation from Biogen, Sanofi, Merck Serono, Novartis, and Roche. S. Galgani received fees as invited speaker or travel expenses for attending meeting from Biogen, Merck‐Serono, Teva, Almirall, Sanofi‐Aventis, Novartis, and Genzyme. L.M. Caniatti has nothing to disclose. A. Lugaresi has served as a Biogen, Merck Serono, Novartis, Roche, Sanofi/Genzyme, and Teva Advisory Board Member. She received congress and travel/accommodation expense compensations or speaker honoraria from Biogen, Merck, Mylan, Novartis, Sanofi/Genzyme, Teva, and Fondazione Italiana Sclerosi Multipla (FISM). Her institutions received research grants from Novartis. S. Romano reports fees as speaker and travel expense refunds from Biogen, Novartis, and Roche. P. Iaffaldano has served on scientific advisory boards for Biogen Idec, Bayer, Teva, Roche, Merck Serono, Novartis, and Genzyme and has received funding for travel and/or speaker honoraria from Sanofi Aventis, Genzyme, Biogen Idec, Teva, Merck Serono, and Novartis. R. Saccardi has nothing to disclose. E. Angelucci is DMC member for Celgene and VERTEX-CRISPR-CAS9, Adv board for Novartis, BlueBirdBio, and Gilead. G.L. Mancardi received support from Biogen Idec (honoraria for lecturing, travel expenses for attending meetings, and financial support for research), Genzyme (honorarium for lecturing), Merck Serono, Novartis, Teva (financial support for research), and Sanofi Aventis (honorarium for speaking). M.P. Sormani received consulting fees from Biogen Idec, Merck Serono, Teva, Genzyme, Roche, Novartis, GeNeuro, and Medday. M. Inglese received grants NIH, NMSS, and FISM and received fees for consultation from Roche, Genzyme, Merck, Biogen, and Novartis. Go to Neurology.org/N for full disclosures.

Figures

**Figure 1. Time to Confirmed Disability Progression in Patients With SPMS Treated With AHSCT and Matched Patients Treated With Other Anti-inflammatory DMTs**
Kaplan-Meier Curve for Time to First Confirmed Progression for (A) Propensity Score–Matched Treatment Groups and (B) the Overlap Weighting–Matched Groups. Abbreviations: AHSCT = autologous hematopoietic stem cell transplantation; DMTs = disease-modifying therapies (Beta interferons, azathioprine, Glatiramer Acetate, Mitoxantrone, Fingolimod, Natalizumab, Methotrexate, Teriflunomide, Cyclophosphamide, Dimethyl Fumarate, and Alemtuzumab); EDSS = Expanded Disability Status Scale; HR = hazard ratio; SPMS = secondary progressive multiple sclerosis.

**Figure 2. Evolution of Neurologic Disability in Patients With SPMS Treated With AHSCT and Matched Patients Treated With Other Anti-inflammatory DMTs**
Annualized EDSS Change Together With 95% CIs 1–10 years after Treatment Start for (A) Propensity Score–Matched Treatment Groups and (B) the Overlap Weighting–Matched Groups. Abbreviations: AHSCT = autologous hematopoietic stem cell transplantation; DMTs = disease-modifying therapies (Beta Interferons, azathioprine, Glatiramer Acetate, Mitoxantrone, Fingolimod, Natalizumab, Methotrexate, Teriflunomide, Cyclophosphamide, Dimethyl Fumarate, and Alemtuzumab); EDSS = Expanded Disability Status Scale; SPMS = secondary progressive multiple sclerosis.

Figure 3. Time to Confirmed Disability Improvement and Prevalence of Disability Improvement in Patients With SPMS Treated With AHSCT and Propensity Score–Matched Patients Treated With Other Anti-inflammatory DMTs
(A) Kaplan-Meier Curve for Time to First Confirmed Disability Improvement. (B) Prevalence of Confirmed Disability Improvement 1–10 years after Treatment Start.Abbreviations: AHSCT = autologous hematopoietic stem cell transplantation; DMT = disease-modifying therapies (beta interferons, azathioprine, glatiramer acetate, mitoxantrone, fingolimod, natalizumab, methotrexate, teriflunomide, cyclophosphamide, dimethyl fumarate, and alemtuzumab); EDSS = Expanded Disability Status Scale; SPMS = secondary progressive multiple sclerosis.

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Hematopoietic Stem Cell Transplantation in People With Active Secondary Progressive Multiple Sclerosis

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Hematopoietic Stem Cell Transplantation in People With Active Secondary Progressive Multiple Sclerosis

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