Clinical Stabilization and Effective B-Lymphocyte Depletion in the Cerebrospinal Fluid and Peripheral Blood of a Patient With Fulminant Relapsing-Remitting Multiple Sclerosis
Open Access
- 1 October 2005
- journal article
- case report
- Published by American Medical Association (AMA) in Archives of Neurology
- Vol. 62 (10), 1620-1623
- https://doi.org/10.1001/archneur.62.10.1620
Abstract
BackgroundThe anti-CD20 monoclonal antibody rituximab effectively depletes B lymphocytes and has been successfully used in the therapy of immune-mediated disorders of the peripheral nervous system. A limited effect of rituximab on B lymphocytes in the cerebrospinal fluid compartment of patients with primary progressive multiple sclerosis (MS) was recently reported.ObjectiveTo determine the effect of rituximab on clinical, magnetic resonance imaging, and immunological variables in a patient with relapsing-remitting MS.DesignA patient with relapsing-remitting MS was treated with rituximab. The patient was repeatedly examined clinically and by magnetic resonance imaging. The frequency of peripheral blood and cerebrospinal fluid B lymphocytes was assessed by flow cytometry before, during, and after rituximab therapy.ResultsRituximab monotherapy resulted in significant clinical improvement. Inflammatory surrogate markers on magnetic resonance imaging were also reduced. B lymphocytes were depleted in the cerebrospinal fluid and peripheral blood.ConclusionsOur data demonstrate beneficial clinical effects of rituximab in relapsing-remitting MS, mediated through modulation of humoral systemic and central nervous system intrinsic immune responses. Clinical trials should determine optimal therapeutic strategies for patients with relapsing-remitting MS.Keywords
This publication has 16 references indexed in Scilit:
- Multiple sclerosis – novel insights and new therapeutic strategiesCurrent Opinion in Neurology, 2005
- Rituximab stabilizes multifocal motor neuropathy increasingly less responsive to IVIgNeurology, 2004
- Detection of Ectopic B‐cell Follicles with Germinal Centers in the Meninges of Patients with Secondary Progressive Multiple SclerosisBrain Pathology, 2004
- Single-Cell Repertoire Analysis Demonstrates that Clonal Expansion Is a Prominent Feature of the B Cell Response in Multiple Sclerosis Cerebrospinal FluidPublished by The American Association of Immunologists ,2003
- Treatment of IgM antibody associated polyneuropathies using rituximabJournal of Neurology, Neurosurgery & Psychiatry, 2003
- Rituximab: Ongoing and future clinical developmentSeminars in Oncology, 2002
- Patterns of cerebrospinal fluid pathology correlate with disease progression in multiple sclerosisBrain, 2001
- IgM antibody-related polyneuropathies: B-cell depletion chemotherapy using RituximabNeurology, 1999
- Multiple sclerosis: In situ evidence for antibody‐ and complement‐mediated demyelinationAnnals of Neurology, 1998
- Heterogeneity in the B1 (CD20) cell surface molecule expressed by human B-lymphocytesMolecular Immunology, 1988