Incidence of malignant neoplasms and mortality in people affected by multiple sclerosis in the epoch of disease-modifying treatments: A population-based study on Tuscan residents.

Background: Conflicting data are currently available on the risk of malignancies in people affected by multiple sclerosis (pwMS), and the potential relative contribution to this risk of disease-modifying therapies (DMTs) is still debated. Moreover, data on the long-term prognosis of pwMS mostly derive from natural history studies and updated observations during the treatment era are lacking.

Methods: Incidence of cancer and mortality were analysed in a pwMS cohort of residents of Tuscany over a 17-year period of observation during the treatment era and compared with the rates observed in a 1:10 sex- and age-matched control population resident in the same geographical area.

Autologous haematopoietic stem cell transplantation versus low-dose immunosuppression in secondary-progressive multiple sclerosis.

Background And Purpose: Effectiveness of autologous haematopoietic stem cell transplantation (AHSCT) in relapsing-remitting multiple sclerosis (MS) is well known, but in secondary-progressive (SP)-MS it is still controversial. Therefore, AHSCT activity was evaluated in SP-MS using low-dose immunosuppression with cyclophosphamide (Cy) as a comparative treatment.

Methods: In this retrospective monocentric 1:2 matched study, SP-MS patients were treated with intermediate-intensity AHSCT (cases) or intravenous pulses of Cy (controls) at a single academic centre in Florence.

Sustained disease remission after discontinuation of disease modifying treatments in relapsing-remitting multiple sclerosis.

Background: The natural history of multiple sclerosis (MS) following discontinuation of a first-line disease-modifying treatment (DMT) in relapsing-remitting (RR-) MS patients is controversial, as few data are available on the risk of disease reactivation. This study aims to investigate the disease course after DMT discontinuation in selected RR-MS patients, exploring potential predictive factors of disease reactivation.

Methods: RR-MS patients, aged 18-65, who had discontinued a first-line DMT were selected from 1107 clinical records.

Impact of autologous haematopoietic stem cell transplantation on disability and brain atrophy in secondary progressive multiple sclerosis.

Background: Autologous haematopoietic stem cell transplantation (aHSCT) is a valuable option in aggressive relapsing-remitting multiple sclerosis (MS), but its efficacy in secondary progressive (SP)-MS is still controversial.

Objective: Assessing efficacy of aHSCT in SP-MS by clinical-radiological outcomes.

Methods: Open-label monocentric retrospective study enrolling consecutive SP-MS patients treated with BEAM-aHSCT in the period 1999-2016.

Disease reactivation following fingolimod withdrawal in multiple sclerosis: Two case reports.

Background: Severe multiple sclerosis reactivation following second line treatment withdrawal, defined "rebound syndrome", is becoming a prominent issue to consider when deciding to discontinue a treatment. In particular disease recurrence after cessation of fingolimod is actually poorly characterized as to date, only case reports and small case series have been described.

Case Presentation: We herewith describe 2 cases of severe disease reactivation associated to a high number of brain gadolinium enhancing lesions at magnetic resonance imaging (MRI) despite high dose steroid treatment, observed a few weeks after cessation of fingolimod administration, causing a substantial and persistent worsening of patient disability that required long term hospitalization.