As we learn more about the long term effects of chemotherapy of the central nervous system, it is vitally important that people with MS are given the facts.
If you are being recommended to try any of these therapies, please discuss the side effects with your doctor.
2. Chemotherapy changes the brain's metabolism-- Doctors have long-described "chemo brain"--a common and debilitating side effect of chemotherapy, causing cognitive fog and a loss of coping skills. In fact, the brain's metabolism is altered.
With the help of special software, they were able to pinpoint differences in brain metabolism before and after chemo. They then correlated these with patient history and data from neurologic exams and chemo treatments. The analysis reveals a statistically significant link between reductions in regional brain metabolism and symptoms of chemo brain. Lagos says their findings show "there are specific areas of the brain that use less energy following chemotherapy".
"These brain areas are the ones known to be responsible for planning and prioritizing," she adds.
3. Chemotherapy used in bone marrow transplant doubles brain atrophy in those with progressive MS. Because of this, one neurologist is now cautioning his progressive MS patients. The chemotherapy used in bone marrow transplant is likely to accelerate the disease progression in those with progressive MS.
4. Current information on Lemtrada (Campath/Alemtuzumab)
New claims are that treatment reduced cerebral atrophy in RRMS patients who were followed for two years---but earlier studies showed that this was not true in secondary progressive MS. Treated patients were followed for 14 years past infusions---and cerebral atrophy and disease progression continued. The FDA was right to deny Lemtrada in the US---sadly, the MS patients that are asking for this treatment to be approved have been given an incomplete scenario.
Unfortunately, this did not lead to a clinical improvement in the disability in these patients. In fact, their disability worsened with time at a rate of 0.02 EDSS points for each patient each year. Evidence for continued neurodegeneration in these patients was shown by progressive cerebral atrophy on follow-up MRI scanning. This particular group of patients who showed continuing disease progression had the highest inflammatory load prior to commencing alemtuzumab therapy. This group of patients were followed up with MRI scanning many years later (14 years post treatment) and did not demonstrate any increase in lesion load but did demonstrate further cerebral atrophy [Coles et al. 2006]. This was reflected in their EDSS score, the median being 7.5 (range 4.5–9) at latest follow up [Hill-Cawthorne et al. 2012].
Campath 1H treatment was associated with a sustained and marked reduction in the volume of Gd enhancement, indicating suppression of active inflammation. Nevertheless, many patients developed increasing brain and spinal cord atrophy, T1 hypointensity, and disability.
In fact, neurologists have known about chemotherapy causing brain atrophy for many years. Here is a study from 2006--where neurologists followed brain atrophy after chemotherapy in preparation for a bone marrow transplant. And they included a man without MS, being treated for cancer, to see how his brain did. His brain atrophy doubled....just like the people with MS.
The man with non-Hodgkin lymphoma provided a clue. Because he didn't have MS, he should not have had any cerebral inflammation or edema. Yet, in the three months after he received the same treatment as the MS patients, his brain shrank at the rate of about 6 percent per year, a rate of atrophy similar to the MS patients.
We still do not fully understand the disease mechanism of MS. While MS specialists continue to operate under the assumption that a faulty immune system must be annihilated ----we are learning that the true progression of MS can be linked to neuronal loss, or brain atrophy. There is a terrible and tragic irony in the fact that chemotherapies, which are known to double brain atrophy rates, are being recommended to people with MS.
Please, share this information in the MS community. For those who have already been treated with chemotherapies, there is hope of healing through diets high in antioxidants and phytonutrients and omega 3 oil supplementation. In fact, simple lifestyle factors like diet, exercise, UV rays and vitamin D are increasing blood flow to the brain are helping reverse brain atrophy in all of those with MS.
Know the facts, and be well,