To report the first patient with multiple sclerosis (MS) like neuroinflammation following allogeneic haematopoietic stem cell transplantation (HSCT), who was treated with a ‘domino’ autologous HSCT.

A 53-year-old male was treated with allogeneic HSCT for lymphoid blast transformation of chronic myeloid leukaemia.  Ten months later he presented with confusion, slurred speech, left sided facial weakness and ataxia.  He had no systemic features suggestive of graft versus host disease, such as rash, deranged liver function or gastrointestinal disturbance.  MRI brain scan showed multiple enhancing tumefactive lesions.  After extensive investigations for infections and recurrence of malignancy, he underwent brain biopsy, which showed demyelination.  Although symptoms improved with corticosteroids, relapse occurred after five months and he was diagnosed with MS.  The disease followed an aggressive course and did not respond to glatiramer acetate and natalizumab.  His EDSS score reached 8 within 2 years from the first presentation of neuroinflammation.  The patient was treated with a ‘domino’ autologous HSCT, where the patient, a recipient of previous allogeneic transplant serving as a ‘donor’ for his second transplant.  It produced a transient response but failed to induce long-term disease remission.  He was treatment with ocrelizumab, but he died of progressive disease 4 months later.