Q&A-8 for paying subscribers

What are the MRI criteria for defining active PPMS? Is BK virus reactivation a problem for people with MS having AHSCT? I have SPMS should I switch from glatiramer acetate to siponimod?

Questions

Q1: I would like to ask you about what is considered imaging features characteristic of inflammatory activity in PPMS. As far as I know, this is one of the criteria for getting ocrelizumab in PPMS. Unfortunately, I am getting contradictory answers from local neurologists. How old should the MRIs be before a decision is made for ocrelizumab? Anything other than gadolinium-enhancing lesions would qualify? E.g. new lesions within what time frame? How many new lesions?

Q2: How many AHSCT patients have the BK  virus activated? Does this virus need CD19/CD20 to clear it, or just the T cells?

Q3: My neurologist said I now have secondary progressive MS and recommended switching me from glatiramer acetate (Copaxone) to siponimod (Mayzent). Do you agree? 

NOTE: General substack newsletters and microsite are free; it is only Q&A sessions that are restricted to paying subscribers. I can't run and maintain the MS-Selfie microsite, hence the need to pay people to help do the work for me. If people want to ask medical questions unrelated to the Newsletters or Podcasts, they either need to become paying subscribers or email (ms-selfie@giovannoni.net) to request a complimentary subscription.

Answers