Cytoxan for refractory MS high dose

Gladstone et al. High dose cyclophosphamide for moderate to severe refractory multiple sclerosis.Arch Neurol 63:10: 1388-1397
Patient selection: EDSS > 3.5 after 2 or more DMD's tried
Methods: 200/mg/kg cyclophosphamide over four days
Outcome measures : MRI neuroopthy exams every six months, EDSS quarterly, QOL measure every two years
Results: 12 patients followed median 16 months none increased EDSS more than 1 point. 5 decreased. Improvements were seen in QOL measure and MRI

Fine points
Mesna, forced diuresis to prevent hemorhhagic cystitis. Antibacterial, antifungal, anti viral prophylaxis used. Patients had median age 41, had disease median 15 years, 7 had tried mitoxantrone. 7/13 had spms. risk of hem cystitis is 2 percent, of transient dilated cardiomyopathy is 1 percent.. Fever, sepsis, zoster were common.

Note medline "Gladstone " for cyclophosphamide in MS CIDP MG