Use of Mitoxantrone in Early Secondary Progressive Multiple Sclerosis:  An Observational Study of 48 Patients with Clinical and MRI Outcomes

Ahmet Kasım Kılıç; Aslı Kurne; Birgül Baştan; İrem Çıkrıkçı; Demet Funda Baş; Mine Buluş; Neslihan Eker; Gülşen Kışlak; Elif Bulut; Kader Karlı Oğuz; Rana Karabudak

Ahmet Kasım Kılıç¹, Aslı Kurne¹, Birgül Baştan¹, İrem Çıkrıkçı¹, Demet Funda Baş¹, Mine Buluş³, Neslihan Eker³, Gülşen Kışlak³, Elif Bulut², Kader Karlı Oğuz², Rana Karabudak¹

¹Faculty Of Medicine, University Of Hacettepe, Department Of Neurology, Ankara, Turkey
²Faculty Of Medicine, University Of Hacettepe, Department Of Radiology, Ankara, Turkey
³Faculty Of Medicine, University Of Hacettepe, Department Of Pharmacy, Subdivision Of Chemotherapy, Ankara, Turkey

Keywords: Multiple sclerosis, immunosuppressive agents, mitoxantrone

Abstract

OBJECTIVE: To report the clinical follow-up, side effects, and magnetic resonance imaging (MRI) findings of mitoxantrone treatment

in patients in the early phase of secondary progressive and exacerbating relapsing-remitting multiple sclerosis.

METHODS: Patients that completed and/or were undergoing treatment between 2001 and 2008 were included in the

study. All patients were definitive progressive multiple sclerosis patients and met ‘non-responder’ criteria for immunomodulatory the-

rapy. They did not have active infection, cardiac disease, or any contraindication for immunosuppressive treatment. Baseline comp-

lete blood count, liver function tests, and transthoracic echocardiography were performed. Mitoxantrone was given as induction the-

rapy (1 dose per month for 3 months) and then as maintenance therapy (with 3 month periods, 12 mg/m2 until to the cumulative

dose was reached). Patients were followed-up regularly for the appearance of any side effects.

RESULTS: The study included 33 female and 15 male patients. Mean age was 36.6 ± 7.8 years, mean disease duration was 9.38 ±

4.8 years, mean expanded disease severity scale (EDSS) score was 5.8, and mean treatment duration was 11.16 ± 7.4 months. Fol-

lowing the end of treatment, 17 patients were stabilized, 10 improved, and 14 progressed. There were no side effects observed du-

ring or after treatment in 16 patients. Among the other 32 patients, the observed side effects were as follows: nausea (n= 18), per-

manent leucopenia (n= 1), transient thrombocytopenia (n= 4), alopecia (n= 13), neutropenic fever (n= 1), and amenorrhea (n= 18).

MRI follow-up was performed in a subgroup of patients and showed that the lesion loads were stabilized.

CONCLUSION: We reported the efficacy, and clinical and MRI follow-up results of multiple sclerosis patients treated with mitoxantro-

ne. Patient selection and therapy timing was very important for maximum efficacy. Patients that responded to mitoxantrone treat-

ment benefited beginning with the induction phase and their disability was limited or improved.