Abstract Details

Title Immunosuppresion following alemtuzumab in relapsing-remitting multiple sclerosis patients previously treated with fingolimod

Topic Multiple Sclerosis

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-032

Objective

To investigate the kinetics and relative recovery of CD4 and CD8 T cells, CD19 B, CD56 NK and CD45+ cells after alemtuzumab in patients previously undertaking Fingolimod.

Background

Alemtuzumab induces profound lymphopenia and the rate and degree of recovery vary with cell type. In clinical trials (CT), lymphocyte count recovery after alemtuzumab was followed in patients with injectable immunomodulators as previous DMT and in naive patients.

Design/Methods

A total of 32 patients with RRMS previously treated with Fingolimod underwent the first course of alemtuzumab were followed. Peripheral blood mononuclear cell phenotyping (PBMCP) was performed at baseline and the quarterly. Last PBMCP was done just before of the second course.

Results

Mean age of patients was 34.8±6.4 years and 59,3% were female. One year after first course, a profound depletion of all lymphocyte lines was observed excepting from CD19 lymphocytes, which showed a slight increase. Comparison among cell subsets counts between before the first course and prior to the second course was made. There was significant difference between CD3 (1054±665 vs 465±228 cells/mL, p= 0,005), CD4 (627±471 vs 189±88 cells/mL, p= 0,02) and CD45 (1681±997 vs 1028±365 cells/mL, p= 0,01). Non-significant difference was found between CD19, CD8 and CD56NK. 12,5% of patients had less than 200 CD4+ cells/mL before the first course and 54,16% prior the second cycle (p<0,005). This finding did not delay the second course.

Conclusions Our data show a persistent depletion of CD4 count below 200 cells/mL in a high proportion of patients just before of second course, despite the fact that alemtuzumab is not known to have a significant effect on lymphocyte precursors. It may relate to an the on CD52-expressing thymocytes, a disease-specific impairment of lymphocyte homeostasis in MS or DMT background. The influence of previous depletion of CD4 in long-term efficacy, tolerability and safety of alemtuzumab is currently unknown.

Authors/Disclosures
Jose Maria Cabrera Maqueda PRESENTER	Mr. Cabrera Maqueda has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Rocio Hernandez Clares, MD, PhD (Virgen De La Arrixaca Hospital)	No disclosure on file
Ester Carreon Guarnizo	Ester Carreon Guarnizo has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Ana M. Morales Ortiz	No disclosure on file
Jose Meca Lallana, MD (Hospital Clinico Universitario Virgen De La Arrixaca)	Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sandoz. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bristol-Myers-Squibb. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. The institution of Dr. Meca Lallana has received research support from Merck. The institution of Dr. Meca Lallana has received research support from Novartis. The institution of Dr. Meca Lallana has received research support from Roche. The institution of Dr. Meca Lallana has received research support from Sanofi. The institution of Dr. Meca Lallana has received research support from Biogen.

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