好色先生

好色先生

Explore the latest content from across our publications
Join The AAN

Log In

Forgot Password?
Create New Account

Loading... please wait

Abstract Details

Evaluation of Risk Factors in Developing Lymphopenia and Hypogammaglobulinemia in Anti-CD20 Treated Multiple Sclerosis Patients
Multiple Sclerosis
S29 - Multiple Sclerosis: Disease-modifying Therapy (1:12 PM-1:24 PM)
002
To evaluate risk factors in developing lymphopenia and hypogammaglobulinemia in anti-CD20 treated MS patients.
Anti-CD20 treatment has been associated with both lymphopenia and hypogammaglobulinemia, which can increase the risk of infection. Lymphopenia and age were implicated as risk factors in the recent progressive multifocal leukoencephalopathy case with ocrelizumab. Who develops lymphopenia and hypogammaglobulinemia and the time course is not well understood.
A random sample of 600 patients treated with rituximab at the Rocky Mountain MS Center at the University of Colorado were identified and followed retrospectively. Patients who switched to ocrelizumab remained in the study. Patient characteristics, IgG, IgM, and absolute lymphocyte counts on rituximab/ocrelizumab were analyzed.    

Laboratory data on 546 patients were available including 527 MS and 17 neuromyelitis optica spectrum disorder patients with mean disease duration of 9.2 years, mean age of 44.1, 68.7% women and 76.5% Caucasians. Patients were followed for a mean of 30.2 months with a mean cumulative rituximab dose of 3,312mg. Of the 527 MS patients, 96(17.6%) switched to ocrelizumab (mean cumulative ocrelizumab dose of 1,175mg). Fifty-seven(10.4%) patients had lymphopenia(≤500cells/mm3), 38(7.4%) low IgG(≤500 mg/dL), and 143(37.9%) low IgM(≤40 mg/dL). Respectively, mean time to lymphopenia, low IgG, and low IgM were 11.3, 36.1 and 19.7 months. Of patients who developed low IgG(≤500 mg/dL), 73.9% had a preceding(34.8%) or concurrent initial low IgM(39.1%). Higher doses (per gram) of anti-CD20 increased the odds of low IgG(OR: 1.28, 95% CI: 1.12-1.47; p<0.001) and low IgM(OR: 1.31, 95% CI: 1.18-1.45; p<0.001), but not of lymphopenia (p=0.246). Increasing age was associated with an increased odds of lymphopenia(OR: 1.03, 95% CI: 1.00-1.05; p=0.030), but not low IgG(p=0.27) or IgM(p=0.18).
MS patients treated with anti-CD20 therapies frequently develop low IgM early. Lymphopenia and low IgG develop slowly but should be monitored.
Authors/Disclosures
Brandi L. Vollmer, MPH (Columbia University, Anschutz Medical Campus)
PRESENTER 		Ms. Vollmer has nothing to disclose.
Timothy L. Vollmer, MD, FAAN The institution of Dr. Vollmer has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen IDEC. The institution of Dr. Vollmer has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech/Roche. The institution of Dr. Vollmer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Siranax. The institution of Dr. Vollmer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Celgene. The institution of Dr. Vollmer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. The institution of Dr. Vollmer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Meyers Squib. The institution of Dr. Vollmer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Viela Bios. The institution of Dr. Vollmer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. The institution of Dr. Vollmer has received research support from Rocky Mountain MS Center. The institution of Dr. Vollmer has received research support from Biogen. The institution of Dr. Vollmer has received research support from Actelion. The institution of Dr. Vollmer has received research support from Genentech/Roche. The institution of Dr. Vollmer has received research support from Anokion. The institution of Dr. Vollmer has received research support from TG Therapeutics.
John Corboy, MD, FAAN (U of Colorado School of Medicine) Dr. Corboy has received personal compensation for serving as an employee of U of Coloado. Dr. Corboy has received personal compensation for serving as an employee of Rocky Mountain MS Center. Dr. Corboy has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Mylan. Dr. Corboy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Myers Squib. Dr. Corboy has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. Dr. Corboy has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Neurological Association. Dr. Corboy has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Mylan. The institution of Dr. Corboy has received research support from MedDay. The institution of Dr. Corboy has received research support from Novartis. The institution of Dr. Corboy has received research support from NMSS. The institution of Dr. Corboy has received research support from PCORI. The institution of Dr. Corboy has received research support from EMD Serono.
Enrique Alvarez, MD, PhD (University of Colorado) Dr. Alvarez has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Alvarez has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Alvarez has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celgene/BMS. The institution of an immediate family member of Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon.