An aggressive form of MOGAD treated with aHSCT: A case report

Area of Science:

• Neuroimmunology
• Demyelinating diseases of the central nervous system
• Autoimmune disorders

Background:

• Myelin-oligodendrocyte-glycoprotein antibody-associated disease (MOGAD) can present with severe relapses and disability, challenging treatment approaches.
• Current treatments for MOGAD are often adapted from neuromyelitis optica spectrum disorder (NMOSD) and rely on clinical experience.
• Aggressive forms of MOGAD necessitate the exploration of novel and effective therapeutic strategies.

Observation:

• A 56-year-old male diagnosed with MOGAD experienced recurrent optic neuritis followed by severe spinal cord inflammation with tumefactive lesions.
• The patient exhibited persistent disease activity and relapses despite multiple treatments including high-dose steroids, rituximab, tocilizumab, IVIg, and plasma exchange.
• Conventional therapies failed to control the aggressive, treatment-refractory MOGAD.

Findings:

• Autologous hematopoietic stem cell transplantation (aHSCT) was performed following a myeloablative conditioning regimen.
• The patient achieved sustained disease remission with no evidence of disease activity for over two years post-aHSCT.
• aHSCT demonstrated a favorable safety profile in this patient with aggressive MOGAD.

Implications:

• Autologous hematopoietic stem cell transplantation (aHSCT) represents a viable therapeutic option for severe, treatment-refractory MOGAD.
• This case highlights the potential of aHSCT to induce long-term remission in aggressive demyelinating disorders.
• Further research is warranted to establish the role of aHSCT in the management of MOGAD and other refractory autoimmune neurological conditions.