- Autoimmune encephalitis following alemtuzumab treatment of multiple sclerosis. [Journal Article]
- MSMult Scler Relat Disord 2018 Dec 03; 28:31-33
- Secondary autoimmune disorders are a recognised complication of alemtuzumab treatment for multiple sclerosis. We report a case of autoimmune encephalitis manifesting as a polymorphic epilepsia partia...
Secondary autoimmune disorders are a recognised complication of alemtuzumab treatment for multiple sclerosis. We report a case of autoimmune encephalitis manifesting as a polymorphic epilepsia partialis continua / status epilepticus seven months after the second course of alemtuzumab in a patient with previous autoimmune hypothyroidism and immune thrombocytopenic purpura. An MRI revealed multifocal cortical abnormalities and neuronal loss was evident on biopsy. Although testing for anti-neuronal antibodies was negative, the patient responded well to immunotherapy including plasma exchange. This is the first reported presentation of an autoimmune encephalopathy secondary to alemtuzumab therapy.
- Administration of Subcutaneous Monoclonal Antibodies in Patients With Cancer. [Journal Article]
- ONOncol Nurs Forum 2019 Jan 13; 46(1):E38-E47
- CONCLUSIONS: SC mAbs require slow administration (no less than five minutes), and the injection site should be changed at each cycle. Patient guidelines should include information about expected adverse effects, signs or symptoms of side effects requiring emergency care, and how to reduce potential discomfort caused by the injection.
- Cost-utility analysis of alemtuzumab in comparison with interferon beta, fingolimod, and natalizumab treatment for relapsing-remitting multiple sclerosis in Austria. [Journal Article]
- JMJ Med Econ 2018 Dec 07; :1-19
- CONCLUSIONS: The analysis shows that alemtuzumab is a cost-saving alternative to treat RRMS in pretreated and therapy naïve patients. From the patient perspective alemtuzumab improves quality of life.
- Prospective phase II clinical trial of autologous haematopoietic stem cell transplant for treatment refractory multiple sclerosis. [Journal Article]
- JNJ Neurol Neurosurg Psychiatry 2018 Dec 11
- CONCLUSIONS: The EFS in our MS cohort is significantly greater than other high-efficacy immunosuppressive therapies and similar to other AHSCT studies despite a more heavily pretreated cohort.
- Recurrent and universal alopecia areata following alemtuzumab treatment in multiple sclerosis: A secondary autoimmune disease. [Journal Article]
- MSMult Scler Relat Disord 2018 Dec 03; 27:406-408
- Acute Thrombotic Microangiopathy and Cortical Necrosis Following Administration of Alemtuzumab: A Case Report. [Journal Article]
- AJAm J Kidney Dis 2018 Dec 07
- Alemtuzumab, a humanized monoclonal antibody that targets CD52 antigens on lymphocytes and monocytes, has shown efficacy in preventing relapse in relapsing-remitting multiple sclerosis. Despite known...
Alemtuzumab, a humanized monoclonal antibody that targets CD52 antigens on lymphocytes and monocytes, has shown efficacy in preventing relapse in relapsing-remitting multiple sclerosis. Despite known severe (yet rare) renal side effects such as anti-glomerular basement membrane disease and membranous glomerulopathy, to our knowledge, alemtuzumab has never been documented to cause drug-induced thrombotic microangiopathy. We describe a 39-year-old woman with relapsing-remitting multiple sclerosis who developed acute kidney injury requiring renal replacement therapy after 1 dose of alemtuzumab, as well as microangiopathic hemolytic anemia and thrombocytopenia. Pathologic examination of a kidney biopsy specimen demonstrated extensive cortical necrosis and arteriolar fibrin thrombi with nonspecific immunofluorescence staining of immunoglobulin M and C3 and absence of immune deposits on electron microscopy. These findings were consistent with the diagnosis of acute thrombotic microangiopathy. She received dexamethasone and underwent plasmapheresis, which was unsuccessful at removing alemtuzumab. The patient received renal replacement therapy for approximately 7 weeks, followed by slow recovery of kidney function that returned close to her baseline.
- Alternative donor transplants for severe aplastic anemia. [Review]
- HAHematology Am Soc Hematol Educ Program 2018 Nov 30; 2018(1):467-473
- Allogeneic hematopoietic stem-cell transplantation remains the only curative treatment for patients with acquired severe aplastic anemia (SAA). When a matched sibling is not available, one can search...
Allogeneic hematopoietic stem-cell transplantation remains the only curative treatment for patients with acquired severe aplastic anemia (SAA). When a matched sibling is not available, one can search for a matched unrelated donor or a cord blood unit (CB) in the international registries or, more recently, for an HLA haploidentical (HAPLO) family member. International guidelines call for a course of antithymocyte globulin (ATG) and cyclosporine before a patient with SAA receives a transplant from a donor other than an HLA identical sibling, but whether this is necessary for patients age <20 years is less clear. Here I will examine the rapid increase in HAPLO transplantations for SAA, showing encouraging early results both in children and young adults. Graft-versus-host disease prophylaxis remains of primary importance in patients with SAA, and in vivo T-cell depletion with either ATG or alemtuzumab offers a significant survival advantage. Finally, I will discuss the strong age effect, which is particularly evident at >40 and 50 years of age for reasons not entirely clear and which should be taken into account when designing a treatment strategy for a given patient.
- Clinical and economic impact of the cytomegalovirus infection among children undergoing allogeneic hematopoietic cell transplantation. [Journal Article]
- BBBiol Blood Marrow Transplant 2018 Nov 28
- Literature on the impact of cytomegalovirus (CMV)-related hospitalization in allogeneic hematopoietic cell transplant (alloHCT) pediatric patients is limited. The aim of this study was to determine u...
Literature on the impact of cytomegalovirus (CMV)-related hospitalization in allogeneic hematopoietic cell transplant (alloHCT) pediatric patients is limited. The aim of this study was to determine utilization and outcomes of CMV-related hospitalization in alloHCT patients using a single-center clinical database. This was a retrospective study of 240 children ages 3 months to 21 years old who were transplanted between 2005 and 2016. Impact of CMV-related length of stay (LOS) and total healthcare costs were quantified. Factors associated with prolonged CMV viremia (>25 days) were also examined. The median age of patients was 9.5 years old. In at risk CMV patients, the incidence of CMV viremia was 38% (59/155), the median time to onset was 33 days (range 0-292 days), and the median time to resolution was 25 days (range 3-148 days, n=53). CMV infection was associated with an increase in LOS of 23.3 days (p=0.004) and added hospital costs of US$45,443 (p=0.162) compared to patients without CMV infection. In multivariable analysis, alemtuzumab (p=0.027) was associated with CMV viremia >25 days. In conclusion, CMV viremia is associated with prolonged LOS and higher hospital care costs and indicates a need for improved and cost-effective CMV prevention strategies. Further study into patient outcomes and costs in alloHCT pediatric populations is needed.
- Multiple Sclerosis: A Global Concern with Multiple Challenges in an Era of Advanced Therapeutic Complex Molecules and Biological Medicines. [Journal Article]
- BBiomedicines 2018 Nov 30; 6(4)
- Multiple sclerosis (MS) has become a common neurological disorder involving populations previously considered to be infrequently affected. Genetic dissemination from high- to low-risk groups is a det...
Multiple sclerosis (MS) has become a common neurological disorder involving populations previously considered to be infrequently affected. Genetic dissemination from high- to low-risk groups is a determining influence interacting with environmental and epigenetic factors, mostly unidentified. Disease modifying therapies (DMT) are effective in treating relapsing MS in variable degrees; one agent is approved for primary progressive disease, and several are in development. In the era of high-efficacy medications, complex molecules, and monoclonal antibodies (MAB), including anti-VLA4 (natalizumab), anti-CD52 (alemtuzumab), and anti-CD20 (ocrelizumab), obtaining NEDA (no evidence of disease activity) becomes an elusive accomplishment in areas of the world where access to MS therapies and care are generally limited. Countries' income and access to public MS care appear to be a shared socioeconomic challenge. This disparity is also notable in the utilization of diagnostic tools to adhere to the proposed elements of the McDonald Criteria. The impact of follow-on medications ("generics"); injectable non-biological complex drugs (NBCD), oral sphingosine-1-phosphate receptor modulators, and biosimilars (interferon 1-a and 1-b), utilized in many areas of the world, is disconcerting considering these products generally lack data documenting their efficacy and safety. Potential strategies addressing these concerns are discussed from an international point of view.
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- Acquired haemophilia A as a secondary autoimmune disease after alemtuzumab treatment in multiple sclerosis: A case report. [Journal Article]
- MSMult Scler Relat Disord 2018 Nov 29; 27:403-405
- Alemtuzumab is a highly effective monoclonal antibody for the treatment of multiple sclerosis (MS). During the immune reconstitution following the use of this treatment severe secondary autoimmune di...
Alemtuzumab is a highly effective monoclonal antibody for the treatment of multiple sclerosis (MS). During the immune reconstitution following the use of this treatment severe secondary autoimmune diseases (SADs) can develop. We present the case of a patient affected by active MS who failed to achieve disease control with several disease-modifying drugs and was thereafter successfully treated with alemtuzumab, obtaining no evidence of disease activity and a high quality of life. Twenty months after the first infusion of alemtuzumab the patient developed acquired haemophilia A (AHA), a treatable but potentially lifethreatening condition that should be considered a possible SADs associated to this drug. In order to allow an early diagnosis and to prevent possible complications of AHA, routine coagulation tests (prothrombin time and activated partial thromboplastin time) should be included in the laboratory serological monitoring of patients treated with alemtuzumab.