Autologous hematopoietic stem cell transplantation versus alemtuzumab in aggressive MS: a retrospective real-word study (4096)

Objective: To evaluate efficacy and safety of series of aggressive relapsing-remitting (RR) MS patients treated with aHSCT and alemtuzumab in a single Italian MS center and followed for 3 years. Background: Aggressive multiple sclerosis (MS) represents almost 10% of all MS cases. Treatment of these patients is challenging and optimal strategies have yet to be defined. Alemtuzumab and autologous hematopoietic stem cells transplantation (aHSCT) represent ideal candidates for managing aggressive MS because of their profound and immediate immune-ablative effects. However, experience is limited and uncertainty remains on correct patient selection. Design/Methods: 61 patients with aggressive MS, according to the criteria of Rush et al. [CA Rush et al. Nat Rev Neurol 2015], were retrospectively collected from the MS center of Genova. 32 patients underwent treatment with alemtuzumab and 29 with aHSCT (conditioning regimen: carmustine/etoposide/ara-C/melphalan (BEAM) or cyclophosphamide). The proportion of patients with complete disease remission (no evidence of activity -NEDA-) was calculated at 3 years. Results: At baseline, aHSCT patients were younger than alemtuzumab patients (t=2.16; p=0.035), had higher EDSS (Mann-Whitney U=106; p Conclusions: Intense immunosuppression followed by aHSCT is superior to alemtuzumab in reducing relapses and MRI activity in aggressive MS and promotes disability improvement. Disclosure: Dr. Lapucci has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Sanofi. Dr. Boffa has nothing to disclose. Dr. Sbragia has nothing to disclose. Dr. Capello has nothing to disclose. Dr. Curro has nothing to disclose. Dr. Laroni has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Merck Serono, Novartis, Biogen, Genzyme and Teva.. Dr. Roccatagliata has nothing to disclose. Dr. Uccelli has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Novartis, Merck Serono, Teva, Genzyme, and Roche. Dr. Uccelli has received research support from Merck-Serono, Biogen, and Novartis.Dr. Gualandi has nothing to disclose. Dr. Mancardi has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Bayer Schering, Biogen Idec, Sanofi Aventis, Teva, Genzyme and Merck Serono Pharmaceuticals.. Dr. Inglese has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Novartis Pharmaceuticals, National Multiple Sclerosis Society, Noto Foundation, NIH, and Teva Neuroscience.