The consequences of delayed diagnosis and treatment in persons with multiple sclerosis given autologous hematopoietic stem cell transplantation
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María de Lourdes Pastelín-Martínez
Abstract
Objectives
We have analyzed the association of delayed both diagnosis and treatment of persons with MS with the long-term results of patients given autologous hematopoietic stem cell transplantation (aHSCT).
Methods
Patients with MS referred to the HSCT-Mexico program were included in the study; in 103, detailed pre- and post-transplant evolution could be recorded. Two groups of patients were analyzed according to the time of evolution between the onset of symptoms and the definite diagnosis of MS: more than 8 months (delayed diagnosis, DD), or less than 8 months (non-delayed diagnosis, NDD). The progression of MS was assessed by changes in the expanded disability status scale (EDSS).
Results
The time elapsed between the onset of symptoms and the correct diagnosis was lower for the NDD group (1.55 vs. 35.87 months, p<0.05). Both groups of patients showed a similar EDSS score at diagnosis (1.5 vs. 1.5); however, the EDSS at the time of the transplant was higher in the DD group (4.5 vs. 3.0, p=0.3) and the response of the EDSS score to the transplant was significantly better for the NDD group, the last EDSS scores being 2.5 vs. 4.25 (p=0.03). Both groups of patients responded to aHSCT by diminishing the EDSS, but the response was significantly better in the NDD group.
Conclusions
These data indicate that both the pre-transplant progression of the disease and the response to aHSCT were significantly worse in the DD group. An early diagnosis and an early aHSCT intervention are critical for a good prognosis, in terms of lowering and stabilizing the motor disability in MS patients given autografts.
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Research ethics: The study was approved by the Ethics Committee of the Clinica RUIZ (Conbioetica 21CEI00120130605, Registry No. 13 CEI 21 114 126).
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Informed consent: Informed consent was obtained from all individuals included in this study, or their legal guardians or wards.
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Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: The authors state no conflict of interest.
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Research funding: None declared.
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Data availability: The raw data can be obtained on request from the corresponding author.
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© 2024 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Opinion Paper
- Exploring synthesis as a vital cognitive skill in complex clinical diagnosis
- Original Articles
- Physiologic measurements of cognitive load in clinical reasoning
- Impact of diagnostic management team on patient time to diagnosis and percent of accurate and clinically actionable diagnoses
- Game-based learning to improve diagnostic accuracy: a pilot randomized-controlled trial
- A patient follow-up intervention to improve medical decision making at an internal medicine residency program
- Application of a diagnosis flow draft based on appearance impression for detection of vulvar disease
- The consequences of delayed diagnosis and treatment in persons with multiple sclerosis given autologous hematopoietic stem cell transplantation
- Troponin testing in routine primary care: observations from a dynamic cohort study in the Amsterdam metropolitan area
- Use of saliva-based qPCR diagnostics for the accurate, rapid, and inexpensive detection of strep throat
- Short Communications
- Improving communication of diagnostic uncertainty to families of hospitalized children
- Association of diagnostic error education and recognition frequency among Japanese medical students: a nationwide cross-sectional study
- Updated statistics on Influenza mortality
- Letters to the Editor
- How case reports can be used to improve diagnosis
- Clinical assessment of Ortho VITROS SARS-CoV-2 antigen chemiluminescence immunoassay
- Convicting a wrong molecule?
- Case Reports - Lessons in Clinical Reasoning
- Lessons in clinical reasoning – pitfalls, myths, and pearls: a woman brought to a halt
- Lessons in clinical reasoning – pitfalls, myths, and pearls: shoulder pain as the first and only manifestation of lung cancer
- Congress Abstracts
- The Future of Diagnosis: Achieving Excellence and Equity
- The Future of Diagnosis: Navigating Uncertainty
Artikel in diesem Heft
- Frontmatter
- Opinion Paper
- Exploring synthesis as a vital cognitive skill in complex clinical diagnosis
- Original Articles
- Physiologic measurements of cognitive load in clinical reasoning
- Impact of diagnostic management team on patient time to diagnosis and percent of accurate and clinically actionable diagnoses
- Game-based learning to improve diagnostic accuracy: a pilot randomized-controlled trial
- A patient follow-up intervention to improve medical decision making at an internal medicine residency program
- Application of a diagnosis flow draft based on appearance impression for detection of vulvar disease
- The consequences of delayed diagnosis and treatment in persons with multiple sclerosis given autologous hematopoietic stem cell transplantation
- Troponin testing in routine primary care: observations from a dynamic cohort study in the Amsterdam metropolitan area
- Use of saliva-based qPCR diagnostics for the accurate, rapid, and inexpensive detection of strep throat
- Short Communications
- Improving communication of diagnostic uncertainty to families of hospitalized children
- Association of diagnostic error education and recognition frequency among Japanese medical students: a nationwide cross-sectional study
- Updated statistics on Influenza mortality
- Letters to the Editor
- How case reports can be used to improve diagnosis
- Clinical assessment of Ortho VITROS SARS-CoV-2 antigen chemiluminescence immunoassay
- Convicting a wrong molecule?
- Case Reports - Lessons in Clinical Reasoning
- Lessons in clinical reasoning – pitfalls, myths, and pearls: a woman brought to a halt
- Lessons in clinical reasoning – pitfalls, myths, and pearls: shoulder pain as the first and only manifestation of lung cancer
- Congress Abstracts
- The Future of Diagnosis: Achieving Excellence and Equity
- The Future of Diagnosis: Navigating Uncertainty
