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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Article info
Publication history
Published online: August 06, 2022
Accepted:
August 5,
2022
Received in revised form:
July 18,
2022
Received:
June 21,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
