{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T12:18:50Z","timestamp":1762431530624,"version":"3.37.3"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,12,14]],"date-time":"2018-12-14T00:00:00Z","timestamp":1544745600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>Natalizumab (<jats:styled-content style=\"fixed-case\">NTZ<\/jats:styled-content>) is a highly effective treatment for relapsing\u2010remitting multiple sclerosis (MS), but its withdrawal is often followed by disease reactivation or rebound, even if other disease\u2010modifying treatments (<jats:styled-content style=\"fixed-case\">DMT<\/jats:styled-content>s) are administered. In this study, for the first time, the safety and efficacy of autologous hematopoietic stem\u2010cell transplantation (<jats:styled-content style=\"fixed-case\">aHSCT<\/jats:styled-content>) performed following<jats:styled-content style=\"fixed-case\">NTZ<\/jats:styled-content>discontinuation were retrospectively compared with conventional<jats:styled-content style=\"fixed-case\">DMT<\/jats:styled-content>s.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with relapsing\u2010remitting MS treated with<jats:styled-content style=\"fixed-case\">NTZ<\/jats:styled-content>who discontinued the drug after at least six administrations and with at least 6\u00a0months of follow\u2010up were included. Patients underwent<jats:styled-content style=\"fixed-case\">aHSCT<\/jats:styled-content>after a minimum of 6\u00a0months following<jats:styled-content style=\"fixed-case\">NTZ<\/jats:styled-content>withdrawal, receiving meanwhile cyclophosphamide or corticosteroids, or other<jats:styled-content style=\"fixed-case\">DMT<\/jats:styled-content>s approved for MS (control group) after an adequate wash\u2010out period. Both hematological and neurological follow\u2010up were assessed according to standard policies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 52 patients were included, 11 who received<jats:styled-content style=\"fixed-case\">aHSCT<\/jats:styled-content>and 41 who received<jats:styled-content style=\"fixed-case\">DMT<\/jats:styled-content>s. Baseline clinical and demographic characteristics were similar between the two groups. No fatality or life\u2010threatening complications, including progressive multifocal leukoencephalopathy, were observed. At 3\u00a0years following<jats:styled-content style=\"fixed-case\">NTZ<\/jats:styled-content>discontinuation, no evidence of disease activity was reported in 54.5% of the patients in the<jats:styled-content style=\"fixed-case\">aHSCT<\/jats:styled-content>group compared with 11.5% of those in the<jats:styled-content style=\"fixed-case\">DMT<\/jats:styled-content>group (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.0212). Disease reactivation in the patients with<jats:styled-content style=\"fixed-case\">aHSCT<\/jats:styled-content>was observed only during wash\u2010out\/bridging therapy and 100% of the cases were free from disease activity after<jats:styled-content style=\"fixed-case\">aHSCT<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These data suggest that an aggressive therapy should be established after<jats:styled-content style=\"fixed-case\">NTZ<\/jats:styled-content>with the shortest possible wash\u2010out period.<jats:styled-content style=\"fixed-case\">aHSCT<\/jats:styled-content>after 6\u00a0months from<jats:styled-content style=\"fixed-case\">NTZ<\/jats:styled-content>withdrawal appears to be safe.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.13866","type":"journal-article","created":{"date-parts":[[2018,11,10]],"date-time":"2018-11-10T11:20:31Z","timestamp":1541848831000},"page":"624-630","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Safety and efficacy of autologous hematopoietic stem\u2010cell transplantation following natalizumab discontinuation in aggressive multiple sclerosis"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1869-7067","authenticated-orcid":false,"given":"A.","family":"Mariottini","sequence":"first","affiliation":[{"name":"Department of Neurosciences Drug and Child Health University of Florence Florence"},{"name":"Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre Careggi University Hospital Florence"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Innocenti","sequence":"additional","affiliation":[{"name":"Cell Therapy and Transfusion Medicine Unit Careggi University Hospital Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"Forci","sequence":"additional","affiliation":[{"name":"Department of Neurosciences Drug and Child Health University of Florence Florence"},{"name":"Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre Careggi University Hospital Florence"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Magnani","sequence":"additional","affiliation":[{"name":"Department of Neurosciences Drug and Child Health University of Florence Florence"},{"name":"Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre Careggi University Hospital Florence"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Mechi","sequence":"additional","affiliation":[{"name":"Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre Careggi University Hospital Florence"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Barilaro","sequence":"additional","affiliation":[{"name":"Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre Careggi University Hospital Florence"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Nistri","sequence":"additional","affiliation":[{"name":"Department of Neurosciences Drug and Child Health University of Florence Florence"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Fani","sequence":"additional","affiliation":[{"name":"Cell Therapy and Transfusion Medicine Unit Careggi University Hospital Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Saccardi","sequence":"additional","affiliation":[{"name":"Cell Therapy and Transfusion Medicine Unit Careggi University Hospital Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"Massacesi","sequence":"additional","affiliation":[{"name":"Department of Neurosciences Drug and Child Health University of Florence Florence"},{"name":"Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre Careggi University Hospital Florence"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. 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