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September 03, 2013; 81 (10) Article

Immune competence after alemtuzumab treatment of multiple sclerosis

Claire L. McCarthy, Orla Tuohy, D. Alastair S. Compston, Dinakantha S. Kumararatne, Alasdair J. Coles, Joanne L. Jones
First published August 7, 2013, DOI: https://doi.org/10.1212/WNL.0b013e3182a35215
Claire L. McCarthy
From the Department of Clinical Neurosciences (C.L.M., O.T., D.A.S.C., A.J.C., J.L.J.), University of Cambridge; and Department of Clinical Immunology (D.S.K.), Addenbrooke's Hospital, Cambridge, UK.
MRCP, PhD
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Orla Tuohy
From the Department of Clinical Neurosciences (C.L.M., O.T., D.A.S.C., A.J.C., J.L.J.), University of Cambridge; and Department of Clinical Immunology (D.S.K.), Addenbrooke's Hospital, Cambridge, UK.
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D. Alastair S. Compston
From the Department of Clinical Neurosciences (C.L.M., O.T., D.A.S.C., A.J.C., J.L.J.), University of Cambridge; and Department of Clinical Immunology (D.S.K.), Addenbrooke's Hospital, Cambridge, UK.
FRCP, PhD
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Dinakantha S. Kumararatne
From the Department of Clinical Neurosciences (C.L.M., O.T., D.A.S.C., A.J.C., J.L.J.), University of Cambridge; and Department of Clinical Immunology (D.S.K.), Addenbrooke's Hospital, Cambridge, UK.
FRCPath, DPhil
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Alasdair J. Coles
From the Department of Clinical Neurosciences (C.L.M., O.T., D.A.S.C., A.J.C., J.L.J.), University of Cambridge; and Department of Clinical Immunology (D.S.K.), Addenbrooke's Hospital, Cambridge, UK.
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Joanne L. Jones
From the Department of Clinical Neurosciences (C.L.M., O.T., D.A.S.C., A.J.C., J.L.J.), University of Cambridge; and Department of Clinical Immunology (D.S.K.), Addenbrooke's Hospital, Cambridge, UK.
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Citation
Immune competence after alemtuzumab treatment of multiple sclerosis
Claire L. McCarthy, Orla Tuohy, D. Alastair S. Compston, Dinakantha S. Kumararatne, Alasdair J. Coles, Joanne L. Jones
Neurology Sep 2013, 81 (10) 872-876; DOI: 10.1212/WNL.0b013e3182a35215

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Abstract

Objective: To determine the immunocompetency of patients with multiple sclerosis treated with the lymphodepleting humanized monoclonal antibody alemtuzumab.

Methods: In this pilot case-control study, we assessed immunocompetence in 24 patients after alemtuzumab treatment by measuring antibody responses to 3 vaccines (diphtheria, tetanus, and poliomyelitis vaccine, Haemophilus influenzae type b and meningococcal group C conjugate vaccine, and pneumococcal polysaccharide vaccine). In 20 patients, antibodies to common viruses (mumps, rubella, varicella-zoster, and Epstein-Barr virus) were measured before alemtuzumab treatment, then at 1 and 9–11 months after treatment. Results were compared with well-defined historical controls.

Results: Serum antibodies against common viruses remained detectable after treatment, and vaccine responses were normal to T-cell–dependent recall antigens (tetanus, diphtheria, and polio), a T-cell–dependent novel antigen (meningococcus C), and T-cell–independent antigens (pneumococcal). There was no evidence for a diminished response to vaccinations in 5 patients studied within 6 months of alemtuzumab treatment.

Conclusion: In this small historically controlled pilot study, we demonstrated i) retained humoral immunologic memory (in the form of antibodies against common viruses and response to recall antigens), and ii) the retained ability to mount a humoral immune response against a novel antigen after treatment with alemtuzumab.

Classification of evidence: This pilot study provides Class III evidence that patients with relapsing-remitting multiple sclerosis appear immunocompetent after treatment with alemtuzumab.

GLOSSARY

GMTR=
geometric mean titer ratio;
Hib=
Haemophilus influenzae type b;
IgG=
immunoglobulin G;
Men C=
meningococcal type C;
MS=
multiple sclerosis;
VZV=
varicella-zoster virus

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at www.neurology.org

  • Received January 6, 2013.
  • Accepted in final form May 6, 2013.
  • © 2013 American Academy of Neurology
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