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Neutropenia complicating anti-CD20 treatment in patients with multiple sclerosis: A retrospective case series and a systematic review of reported cases

  • Author Footnotes
    1 These authors equally contributed to the study.
    Lucrezia Rossi
    Footnotes
    1 These authors equally contributed to the study.
    Affiliations
    Neurology Unit, Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, ASUGI, University of Trieste, Strada di Fiume,447 – 34149, Trieste, Italy
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  • Author Footnotes
    1 These authors equally contributed to the study.
    Alessandro Dinoto
    Footnotes
    1 These authors equally contributed to the study.
    Affiliations
    Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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  • Alessio Bratina
    Affiliations
    Neurology Unit, Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, ASUGI, University of Trieste, Strada di Fiume,447 – 34149, Trieste, Italy
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  • Sara Baldini
    Affiliations
    Neurology Unit, Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, ASUGI, University of Trieste, Strada di Fiume,447 – 34149, Trieste, Italy
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  • Fulvio Pasquin
    Affiliations
    Neurology Unit, Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, ASUGI, University of Trieste, Strada di Fiume,447 – 34149, Trieste, Italy
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  • Antonio Bosco
    Affiliations
    Neurology Unit, Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, ASUGI, University of Trieste, Strada di Fiume,447 – 34149, Trieste, Italy
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  • Arianna Sartori
    Correspondence
    Corresponding author at: Arianna Sartori, Neurology Unit, Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, ASUGI, University of Trieste, Strada di Fiume, 447 – 34149, Trieste, Italy.
    Affiliations
    Neurology Unit, Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, ASUGI, University of Trieste, Strada di Fiume,447 – 34149, Trieste, Italy
    Search for articles by this author
  • Paolo Manganotti
    Affiliations
    Neurology Unit, Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, ASUGI, University of Trieste, Strada di Fiume,447 – 34149, Trieste, Italy
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  • Author Footnotes
    1 These authors equally contributed to the study.
Published:August 06, 2022DOI:https://doi.org/10.1016/j.msard.2022.104090

      Highlights

      • Neutropenia may seldom complicate treatment with anti-CD20 drugs.
      • Late-onset neutropenia was common and frequently symptomatic.
      • Treatment with G-CSF was not associated with relapses.

      Abstract

      Background

      Neutropenia is an infrequent complication of treatment with CD20 depleting agents and may require the administration of granulocyte-colony stimulating factors (G-CSF), which have been associated with an increased relapse risk in patients with multiple sclerosis (PwMS). The management of this side effect is still matter of debate.

      Methods

      Aim of this study is to evaluate the clinical features and the management of neutropenia occurring in anti-CD20 treated PwMS through a single-center case series and a systematic review of the literature, performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

      Results

      A total of 19 patients were included (3 from our clinical experience, 16 from the systematic review). Median age was 38 years-old (25-69) and nearly 70% were female, most of these patients had already received a median of 3 (0-4) previous treatments. Neutropenia occurred in 11 patients treated with ocrelizumab and 8 with rituximab, after a median of 2 (1-7) infusions and 9.5 (1-42) months from the first infusion. Most of these patients had late-onset neutropenia, that occurred after a median time of 90 days (2-156). About 70% of patients were symptomatic and most were treated with G-CSF or antibiotics. No relapses after G-CSF were reported. In those who did not suspend anti-CD20 (68.8%), neutropenia reoccurred in 18.2% of cases. Finally, switching between rituximab and ocrelizumab seem not to affect the occurrence of neutropenia.

      Conclusion

      Our data provides practical evidence regarding the occurrence and the management of neutropenia during treatment with anti-CD20 in PwMS.

      Keywords

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