Alemtuzumab induced red cell aplasia and other immune cytopenias – not so ‘pure’

Immunotherapy ◽  
2021 ◽  
Author(s):  
Lucy Aitken ◽  
Ronak Patel ◽  
James D'Rozario ◽  
Philip Choi
Keyword(s):  
Immune Thrombocytopenia ◽  
High Dose ◽  
Red Cell ◽  
Autoimmune Neutropenia ◽  
Red Cell Aplasia ◽  
Relapsing Remitting ◽  
Bone Marrow Function ◽  
Immune Neutropenia ◽  
Relapsing Remitting Multiple Sclerosis ◽  
Subsequent Improvement

We report on the presentation and outcome of a 28-year-old female who developed red cell aplasia following alemtuzumab therapy for relapsing remitting multiple sclerosis. The patient also developed synchronous immune thrombocytopenia and immune neutropenia, but not aplastic anemia. This patient received high dose steroids, intravenous immunoglobulin (iv.Ig), rituximab, red cell transfusions, vincristine, G-CSF, cyclosporin and mycophenolate to treat the combination of cytopenias over a period of 6 months with subsequent improvement in bone marrow function. While alemtuzumab has several recognized autoimmune complications, little is known about the potential hematological side effects. The combination of red cell aplasia, immune thrombocytic purpura and autoimmune neutropenia has not previously been described in the literature following alemtuzumab immunotherapy and highlights the importance of monthly blood monitoring post alemtuzumab administration.

Effect of high-dose vitamin D3 supplementation on antibody responses against Epstein–Barr virus in relapsing-remitting multiple sclerosis

2016 ◽  
Vol 23 (3) ◽  
pp. 395-402 ◽  
Author(s):  
Egil Røsjø ◽  
Andreas Lossius ◽  
Nada Abdelmagid ◽  
Jonas C Lindstrøm ◽  
Margitta T Kampman ◽  
...  
Keyword(s):  
Vitamin D ◽  
Epstein Barr Virus ◽  
High Dose ◽  
Oral Vitamin ◽  
Barr Virus ◽  
Relapsing Remitting ◽  
Dose Oral ◽  
Epstein Barr ◽  
Antibody Levels ◽  
Relapsing Remitting Multiple Sclerosis

Background: Elevated antibody levels against Epstein–Barr virus (EBV) and a poor vitamin D status are environmental factors that may interact in relapsing-remitting multiple sclerosis (RRMS) aetiology. Objectives: To examine effects of high-dose oral vitamin D3 supplementation on antibody levels against EBV nuclear antigen 1 (EBNA1) in RRMS. Methods: Serum 25-hydroxyvitamin D3 (25(OH)D) and immunoglobulin G antibody levels against EBNA1 (whole protein and amino acid 385–420 fragment), EBV viral capsid antigen (VCA), cytomegalovirus (CMV) and varicella zoster virus (VZV) were measured in 68 RRMS patients enrolled in a 96-week randomised double-blinded placebo-controlled clinical trial of oral vitamin D3 supplementation (20,000 IU/week) (NCT00785473). Results: The mean 25(OH)D level more than doubled in the vitamin D group and was significantly higher than in the placebo group at study conclusion (123.2 versus 61.8 nmol/L, p < 0.001). Compared to the placebo group, both anti-EBNA1 protein and fragment antibody levels decreased in the vitamin D group from baseline to week 48 ( p = 0.038 and p = 0.004, respectively), but not from baseline to week 96. Vitamin D3 supplementation did not affect antibodies against VCA, CMV or VZV. Conclusion: The results indicate that high-dose oral vitamin D3 supplementation can affect humoral immune responses against the latent EBV antigen EBNA1 in RRMS.

High-Dose Methylprednisolone Therapy in Pure Red Cell Aplasia

2002 ◽  
Vol 36 (1) ◽  
pp. 55-58 ◽  
Author(s):  
Gurhan Kadikoylu ◽  
Zahit Bolaman ◽  
Sabri Barutca
Keyword(s):  
Pure Red Cell Aplasia ◽  
High Dose ◽  
Red Cell ◽  
Red Cell Aplasia ◽  
High Dose Methylprednisolone

Determinants of Gd-enhanced MRI response to IFN-β-1a treatment in relapsing-remitting multiple sclerosis

1998 ◽  
Vol 4 (5) ◽  
pp. 403-407 ◽  
Author(s):  
T Koudriavtseva ◽  
C Pozzilli ◽  
M Fiorelli ◽  
C Gasperini ◽  
F Bagnato ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Treatment Period ◽  
Early Response ◽  
High Dose ◽  
Late Response ◽  
Relapsing Remitting ◽  
Change In The Mean ◽  
Remitting Multiple Sclerosis ◽  
Pre Treatment ◽  
Relapsing Remitting Multiple Sclerosis

The decision to use interferon beta (IFN-b) as a treatment for relapsing-remitting multiple sclerosis (RRMS) is based on both clinical characteristics and course of the disease. To better identify the profile of responders, the relationships between baseline clinical/MRI characteristics and therapeutical response was analyzed in 49 patients with RRMS randomly assigned to receive subcutaneously 3 or 9 MIU of IFN-b-1a. The therapeutical response was evaluated as a per cent change in the mean number and volume of monthly Gd-enhancing lesions in both first (early response) and second (late response) 6-month period of treatment, compared to the 6-month pre-treatment period. A better early response was seen in patients with a lower number of relapses during the pre-treatment period, while the late response was favourably influenced by a lower baseline EDSS and the high dose. Our findings suggest that the effect of IFN-b-1a on disease MRI activity is dose-related and dependent on the relapse rate and the level of disability before treatment.

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