Τίτλος:
A case of Alemtuzumab-induced neutropenia in multiple sclerosis in association with the expansion of large granular lymphocytes
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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).
Συγγραφείς:
Vakrakou, A.G.
Tzanetakos, D.
Valsami, S.
Grigoriou, E.
Psarra, K.
Tzartos, J.
Anagnostouli, M.
Andreadou, E.
Evangelopoulos, M.E.
Koutsis, G.
Chrysovitsanou, C.
Gialafos, E.
Dimitrakopoulos, A.
Stefanis, L.
Kilidireas, C.
Εκδότης:
BioMed Central Ltd.
Λέξεις-κλειδιά:
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
DOI:
10.1186/s12883-018-1183-4
