Multiple sclerosis flares associated with recombinant granulocyte colony-stimulating factor.

Area of Science:

• Neurology
• Immunology
• Hematology

Background:

• High-dose immunosuppression with peripheral blood stem cell rescue is a treatment for multiple sclerosis (MS).
• Recombinant human granulocyte colony-stimulating factor (rhG-CSF) is used to stimulate white blood cell recovery after chemotherapy.

Purpose of the Study:

• To report neurologic worsening observed in MS patients undergoing high-dose immunosuppression and stem cell rescue when treated with rhG-CSF.

Main Methods:

• Observational report on 10 patients with MS undergoing high-dose immunosuppression and peripheral blood stem cell rescue.
• Administration of recombinant human granulocyte colony-stimulating factor (rhG-CSF) to stimulate stem cell engraftment.
• Treatment with methylprednisolone for patients experiencing neurologic worsening.

Main Results:

• Four out of 10 patients experienced neurologic worsening during rhG-CSF treatment.
• Three of these patients showed improvement after receiving methylprednisolone.
• One patient died due to respiratory failure, with the exact cause of neurologic worsening remaining uncertain.

Conclusions:

• The use of rhG-CSF in MS patients undergoing high-dose immunosuppression and stem cell rescue may be associated with a risk of neurologic worsening.
• Methylprednisolone may offer some benefit in mitigating these adverse neurologic events.
• Further investigation is needed to elucidate the mechanism behind rhG-CSF-induced neurologic worsening in MS.