TY - JOUR
TI - A case of Alemtuzumab-induced neutropenia in multiple sclerosis in association with the expansion of large granular lymphocytes
AU - Vakrakou, A.G.
AU - Tzanetakos, D.
AU - Valsami, S.
AU - Grigoriou, E.
AU - Psarra, K.
AU - Tzartos, J.
AU - Anagnostouli, M.
AU - Andreadou, E.
AU - Evangelopoulos, M.E.
AU - Koutsis, G.
AU - Chrysovitsanou, C.
AU - Gialafos, E.
AU - Dimitrakopoulos, A.
AU - Stefanis, L.
AU - Kilidireas, C.
JO - BMC Neurology
PY - 2018
VL - 18
TODO - 1
SP - null
PB - BioMed Central Ltd.
SN - 1471-2377
TODO - 10.1186/s12883-018-1183-4
TODO - alemtuzumab;  glatiramer;  natalizumab;  prednisolone;  alemtuzumab;  immunologic factor;  monoclonal antibody, adult;  Article;  blood smear;  case report;  CD3+ CD8+ T lymphocyte;  clinical article;  corticosteroid therapy;  disease association;  disease duration;  disease exacerbation;  drug dose reduction;  drug substitution;  drug withdrawal;  Expanded Disability Status Scale;  female;  flow cytometry;  follow up;  human;  immunophenotyping;  JC virus;  large granular lymphocyte;  leukocyte count;  multiple sclerosis;  neurologic disease;  neurologic examination;  neutropenia;  optic neuritis;  remission;  T lymphocyte;  treatment duration;  treatment outcome;  chemically induced;  lymphocyte;  multiple sclerosis;  neutropenia;  pathology, Adult;  Alemtuzumab;  Antibodies, Monoclonal, Humanized;  Female;  Humans;  Immunologic Factors;  Lymphocytes;  Multiple Sclerosis, Relapsing-Remitting;  Neutropenia
TODO - Background: Alemtuzumab has been demonstrated to reduce the risks of relapse and accumulation of sustained disability in Multiple Sclerosis (MS) patients compared to β-interferon. It acts against CD52, leading primarily to lymphopenia. Recent data have shown that mild neutropenia is observed in 16% of treated MS-patients whereas severe neutropenia occurred in 0.6%. Case presentation: Herein, we present the case of a 34-year-old woman with relapsing-remitting MS, with a history of treatment with glatiramer acetate and natalizumab, who subsequently received Alemtuzumab (12 mg / 24 h × 5 days). 70-days after the last Alemtuzumab administration, the patient displayed neutropenia (500 neutrophils/μL) with virtual absence of B-cells (0.6% of total lymphocytes), low values of CD4-T-cells (6.6%) and predominance of CD8-T-cells (48%) and NK-cells (47%); while large granular lymphocytes (LGL) predominated in the blood-smear examination. Due to prolonged neutropenia (5-days) the patient was placed on low-dose corticosteroids leading to sustained remission. Conclusion: This is the first case of a patient with relapsing-remitting MS with neutropenia two months post-Alemtuzumab, with simultaneous presence of LGL cells in the blood and a robust therapeutic response to prednisolone. We recommend testing with a complete blood count every 15 days in the first 3 months after the 1st Alemtuzumab administration and searching for large granular lymphocytes cell expansion on microscopic examination of the peripheral blood if neutropenia develops. © 2018 The Author(s).
ER -