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The Uhthoff phenomenon: a potential post transplant complication in advanced progressive multiple sclerosis

Bone Marrow Transplantation volume 40, pages 1003–1004 (2007)Cite this article

Autologous haematopoietic stem cell transplantation provides a novel therapeutic option for advanced progressive multiple sclerosis, shown to result in sustained progression-free periods, improved magnetic resonance image (MRI) appearances and increased quality of life in multicentre phase 2 studies.1, 2, 3 Previous reports have documented mild transplant-related adverse events (including mild fever, viral infections and hepatitis). We report the occurrence of acute neurological deterioration associated with significant pyrexia during transplantation.

A 28-year-old man presented in 2003 with impaired balance, dysarthria and right-sided numbness. He reported an isolated episode of vertigo 3 years earlier. Cranial MRI showed white matter abnormalities in keeping with multiple sclerosis and visual evoked potentials that were bilaterally delayed, and CSF (cerebrospinal fluid) examination demonstrated oligoclonal banding. Subsequently, his illness ran an aggressive relapsing remitting course that failed to respond to corticosteroids, interferon-β, glatiramer acetate and mitoxantrone, with a rapid decline in his Expanded Disability Status Score4 from 4.0 to 6.5 over 2 years. In view of his aggressive disease and lack of response to conventional therapy, he was referred for autologous transplantation. A repeat cranial MRI pre-transplant showed extensive white matter changes affecting both cerebral and cerebellar hemispheres extending to the mid-brain, pons and the medulla with no evidence of gadolinium enhancement.

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Authors and Affiliations

  1. Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK

    E S Morris, C D Dalley & J A Snowden

  2. Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK

    B Sharrack

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  1. E S Morris
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  2. B Sharrack
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  3. C D Dalley
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  4. J A Snowden
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Correspondence to E S Morris.

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Morris, E., Sharrack, B., Dalley, C. et al. The Uhthoff phenomenon: a potential post transplant complication in advanced progressive multiple sclerosis. Bone Marrow Transplant 40, 1003–1004 (2007). https://doi.org/10.1038/sj.bmt.1705854

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