Cited by 78Lysosomal Storage Disorders ResearchMultiple Sclerosis Research StudiesMetabolism and Genetic Disorders

Long-term outcomes of allogeneic haematopoietic stem cell transplantation for adult cerebral X-linked adrenoleukodystrophy

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Kühl, Jörn-Sven, Suarez, Felipe, Gillett, Godfrey T., Hemmati, Philipp G., Snowden, John A., Stadler, Michael, Vuong, Giang L., Aubourg, Patrick +2 more·2017·Brain

Abstract

The adult cerebral inflammatory form of X-linked adrenoleukodystrophy is a rapidly progressive neurodegenerative disease, as devastating as childhood cerebral adrenoleukodystrophy. Allogeneic haematopoietic stem cell transplantation has been demonstrated to provide long-term neurological benefits for boys with the childhood cerebral form, but results in adults are sparse and inconclusive. We analysed data from 14 adult males with adult cerebral adrenoleukodystrophy treated with allogeneic haematopoietic stem cell transplantation on a compassionate basis in four European centres. All presented with cerebral demyelinating lesions and gadolinium enhancement. Median age at diagnosis of adult cerebral adrenoleukodystrophy was 33 years (range 21-48 years). In addition to cerebral inflammation, five patients had established severe motor disability from adrenomyeloneuropathy affecting only the spinal cord and peripheral nerves (Expanded Disability Status Scale score ≥ 6). Eight patients survived (estimated survival 57 ± 13%) with a median follow-up of 65 months (minimum 38 months). Death was directly transplant-/infection-related (n = 3), due to primary disease progression in advanced adult cerebral adrenoleukodystrophy (n = 1), or secondary disease progression (n = 2) after transient multi-organ failure or non-engraftment. Specific complications during stem cell transplantation included deterioration of motor and bladder functions (n = 12) as well as behavioural changes (n = 8). Arrest of progressive cerebral demyelination and prevention of severe loss of neurocognition was achieved in all eight survivors, but deterioration of motor function occurred in the majority (n = 5). Limited motor dysfunction (Expanded Disability Status Scale score < 6) prior to transplantation was associated with significantly improved survival [78 ± 14% (n = 9) versus 20 ± 18%(n = 5); P < 0.05] and maintenance of ambulation (Expanded Disability Status Scale score < 7) post-transplant (78% versus 0%; P = 0.021). In contrast, bilateral involvement of the internal capsule on brain MRI was associated with poorer survival [20 ± 18% (n = 5) versus 78 ± 14% (n = 9); P < 0.05]. This study is the first to support the feasibility, complications and potential long-term neurological benefit of allogeneic haematopoietic stem cell transplantation in adult cerebral adrenoleukodystrophy. Further studies are warranted to attempt to improve outcomes through patient selection and optimization of transplantation protocols.

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Research works printed but not linked: 2

  1. Ko ¨hler W, Sokolowski P. A new disease-specific scoring system for adult phenotypes of x-linked adrenoleukodystrophy. J Mol Neurosci 1999; 13: 247-52.
  2. van Geel BM, Bezman L, Loes DJ, Moser HW, Raymond GV. Evolution of phenotypes in adult male patients with X-linked adre- noleukodystrophy. Ann Neurol 2001; 49: 186-94.

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Authors
Kühl, J.-S., Suarez, F., Gillett, G. T., Hemmati, P. G., Snowden, J. A., Stadler, M., Vuong, G. L., Aubourg, P., Köhler, W., & Arnold, R.
Affiliations
  • Charité – Universitätsmedizin Berlin (DE)
  • Northern General Hospital (GB)
  • Stiftung Charité (DE)
  • Royal Hallamshire Hospital (GB)
  • Medizinische Hochschule Hannover (DE)
  • Inserm (FR)
Venue
Brain
Published
2017-03-25
Volume
140
Issue
4
Pages
953-966
ISSN
  • 0006-8950 (ISSN-L)
  • 1460-2156
OpenAlex
W2599975163
Cited by
78
References
37
Citations by year
2026: 5 · 2025: 6 · 2024: 11 · 2023: 6 · 2022: 9 · 2021: 10 · 2020: 10 · 2019: 8 · 2018: 9 · 2017: 3 · 2016: 1
FWCI
6.07
Type
journal article
Language
en
Open access
Locations
  • Brain (publishedVersion)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Lysosomal Storage Disorders Research
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Metabolism and Genetic Disorders
Keywords
allogeneic hematopoietic stem cell transplantation, long-term outcomes, survival, motor impairment, adrenomyeloneuropathy, brain demyelination, Expanded Disability Status Scale
MeSH terms
Adrenoleukodystrophy, Adult, Aftercare, Feasibility Studies, Humans, Male, Middle Aged, Postoperative Complications, Severity of Illness Index, Outcome Assessment, Health Care, Hematopoietic Stem Cell Transplantation, Disease Progression, Young Adult

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