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Pediatric Transplants

Juvenile metachromatic leukodystrophy 10 years post transplant compared with a non-transplanted cohort

Abstract

Metachromatic leukodystrophy (MLD) is a rare inborn error of metabolism leading to severe neurological symptoms and early death. Hematopoietic SCT (HSCT) is considered a treatment option, but results are inconsistent and comparison with natural history is practically missing. We compare a girl with juvenile MLD 10 years after allogeneic HSCT not only with her untreated sister, but also with a large cohort of untreated patients. The girl received HSCT at the age of 5 years when first motor signs appeared. Over 10 years she was stable with respect to her clinical course and gained cognitive abilities. Magnetic resonance imaging (MRI) showed clear regression of white matter changes and magnetic resonance spectroscopy (MRS) demonstrated a reversal of the initial choline increase and N-acetyl-aspartate (NAA) decrease. Only axonal demyelinating neuropathy showed some progression. Her gross motor function and MRI-scores were clearly better compared with her sister and the cohort of untreated patients. Difference to her sister became apparent only 4 years after HSCT. We conclude that HSCT, early in the course of disease, can lead to stabilization of juvenile MLD with a course clearly different from the natural history. HSCT may prevent disease progression, if performed sufficient time before loss of walking, which typically initiates rapid deterioration.

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Acknowledgements

Samuel Groeschel received institutional research support from the German Federal Ministry of Education and Research, the European Commission (LeukoTreat) and from Shire plc. Christiane Kehrer received institutional research support from the German Federal Ministry of Education and Research. The natural-history study was supported by a grant of the German Federal Ministry of Education and Research (BMBF) funding the German LEUKONET (01 GM 0835).

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Correspondence to I Krägeloh-Mann.

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Ingeborg Krägeloh-Mann was member of the scientific board of the Scandinavian biopharmaceutical company ZYMENEX for a world-wide clinical trial I-study for enzyme replacement with the ZYMENEX’s product ‘Metazym’ in 2007. This did not imply any involvement, nor funding in the present study. The remaining authors declare no conflict of interest.

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Krägeloh-Mann, I., Groeschel, S., Kehrer, C. et al. Juvenile metachromatic leukodystrophy 10 years post transplant compared with a non-transplanted cohort. Bone Marrow Transplant 48, 369–375 (2013). https://doi.org/10.1038/bmt.2012.155

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