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Acute effects of alemtuzumab infusion in patients with active relapsing-remitting MS
OBJECTIVE: Alemtuzumab exerts its clinical efficacy by its specific pattern of depletion and repopulation of different immune cells. Beyond long-term immunologic and clinical data, little is known about acute changes in immunologic and routine laboratory parameters and their clinical relevance durin...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853056/ https://www.ncbi.nlm.nih.gov/pubmed/27213173 http://dx.doi.org/10.1212/NXI.0000000000000228 |
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author | Thomas, Katja Eisele, Judith Rodriguez-Leal, Francisco Alejandro Hainke, Undine Ziemssen, Tjalf |
author_facet | Thomas, Katja Eisele, Judith Rodriguez-Leal, Francisco Alejandro Hainke, Undine Ziemssen, Tjalf |
author_sort | Thomas, Katja |
collection | PubMed |
description | OBJECTIVE: Alemtuzumab exerts its clinical efficacy by its specific pattern of depletion and repopulation of different immune cells. Beyond long-term immunologic and clinical data, little is known about acute changes in immunologic and routine laboratory parameters and their clinical relevance during the initial alemtuzumab infusion. METHODS: Fifteen patients with highly active MS were recruited. In addition to parameters including heart rate, blood pressure, body temperature, and monitoring of adverse events, complete blood cell count, liver enzymes, kidney function, acute-phase proteins, serum cytokine profile, complement activation, peripheral immune cell distribution, and their potential of cytokine release were investigated prior to and after methylprednisolone and after alemtuzumab on each day of alemtuzumab infusion. RESULTS: After the first alemtuzumab infusion, both the total leukocyte and granulocyte counts markedly increased, whereas lymphocyte counts dramatically decreased. In addition to lymphocyte depletion, cell subtypes important for innate immunity also decreased within the first week after alemtuzumab infusion. Although patients reported feeling well, C-reactive protein and procalcitonin peaked at serum levels consistent with septic conditions. Increases in liver enzymes were detected, although kidney function remained stable. Proinflammatory serum cytokine levels clearly rose after the first alemtuzumab infusion. Alemtuzumab led to impaired cytokine release ex vivo in nondepleted cells. Normal clinical parameters and mild adverse events were presented. CONCLUSIONS: Dramatic immunologic effects were observed. Standardized infusion procedure and pretreatment management attenuated infusion-related reactions. Alemtuzumab-mediated effects led to artificially altered parameters in standard blood testing. We recommend clinical decision-making based on primarily clinical symptoms within the first alemtuzumab treatment week. |
format | Online Article Text |
id | pubmed-4853056 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-48530562016-05-20 Acute effects of alemtuzumab infusion in patients with active relapsing-remitting MS Thomas, Katja Eisele, Judith Rodriguez-Leal, Francisco Alejandro Hainke, Undine Ziemssen, Tjalf Neurol Neuroimmunol Neuroinflamm Article OBJECTIVE: Alemtuzumab exerts its clinical efficacy by its specific pattern of depletion and repopulation of different immune cells. Beyond long-term immunologic and clinical data, little is known about acute changes in immunologic and routine laboratory parameters and their clinical relevance during the initial alemtuzumab infusion. METHODS: Fifteen patients with highly active MS were recruited. In addition to parameters including heart rate, blood pressure, body temperature, and monitoring of adverse events, complete blood cell count, liver enzymes, kidney function, acute-phase proteins, serum cytokine profile, complement activation, peripheral immune cell distribution, and their potential of cytokine release were investigated prior to and after methylprednisolone and after alemtuzumab on each day of alemtuzumab infusion. RESULTS: After the first alemtuzumab infusion, both the total leukocyte and granulocyte counts markedly increased, whereas lymphocyte counts dramatically decreased. In addition to lymphocyte depletion, cell subtypes important for innate immunity also decreased within the first week after alemtuzumab infusion. Although patients reported feeling well, C-reactive protein and procalcitonin peaked at serum levels consistent with septic conditions. Increases in liver enzymes were detected, although kidney function remained stable. Proinflammatory serum cytokine levels clearly rose after the first alemtuzumab infusion. Alemtuzumab led to impaired cytokine release ex vivo in nondepleted cells. Normal clinical parameters and mild adverse events were presented. CONCLUSIONS: Dramatic immunologic effects were observed. Standardized infusion procedure and pretreatment management attenuated infusion-related reactions. Alemtuzumab-mediated effects led to artificially altered parameters in standard blood testing. We recommend clinical decision-making based on primarily clinical symptoms within the first alemtuzumab treatment week. Lippincott Williams & Wilkins 2016-04-29 /pmc/articles/PMC4853056/ /pubmed/27213173 http://dx.doi.org/10.1212/NXI.0000000000000228 Text en © 2016 American Academy of Neurology This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially. |
spellingShingle | Article Thomas, Katja Eisele, Judith Rodriguez-Leal, Francisco Alejandro Hainke, Undine Ziemssen, Tjalf Acute effects of alemtuzumab infusion in patients with active relapsing-remitting MS |
title | Acute effects of alemtuzumab infusion in patients with active relapsing-remitting MS |
title_full | Acute effects of alemtuzumab infusion in patients with active relapsing-remitting MS |
title_fullStr | Acute effects of alemtuzumab infusion in patients with active relapsing-remitting MS |
title_full_unstemmed | Acute effects of alemtuzumab infusion in patients with active relapsing-remitting MS |
title_short | Acute effects of alemtuzumab infusion in patients with active relapsing-remitting MS |
title_sort | acute effects of alemtuzumab infusion in patients with active relapsing-remitting ms |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853056/ https://www.ncbi.nlm.nih.gov/pubmed/27213173 http://dx.doi.org/10.1212/NXI.0000000000000228 |
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