Evidence map›Paper›PMID 25340086›Full record

ArticleNeurology(R) neuroimmunology & neuroinflammation2014

Massive CNS monocytic infiltration at autopsy in an alemtuzumab-treated patient with NMO.

Jeffrey M Gelfand, Jennifer Cotter, Jeffrey Klingman, Eric J Huang, Bruce A C Cree

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology(R) neuroimmunology & neuroinflammation, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 1 pooled it
4.4field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

33 citing papers in PubMed, 1 synthesis or guideline pooled it, 60 citations in OpenAlex.

  1. Pooled it
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  12. Article
  13. Differential Diagnosis of Pediatric Multiple Sclerosis.Children (Basel, Switzerland) · 2019
    Review
  14. Review
  15. Review
  16. Alemtuzumab as Treatment for Multiple Sclerosis.Cold Spring Harbor perspectives in medicine · 2018
    Review
  17. Functional characterization of reappearing B cells after anti-CD20 treatment of CNS autoimmune disease.Proceedings of the National Academy of Sciences of the United States of America · 2018
    Article
  18. Acute Management of Optic Neuritis: An Evolving Paradigm.Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society · 2018
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 1 institution in 1 country.

Jeffrey M GelfandMS Center, Department of Neurology (J.M.G., B.A.C.C.) and Department of Pathology (J.C., E.J.H.), University of California, San Francisco; and Kaiser Permanente Neurology (J.K.), Walnut Creek, CA.
Jennifer CotterMS Center, Department of Neurology (J.M.G., B.A.C.C.) and Department of Pathology (J.C., E.J.H.), University of California, San Francisco; and Kaiser Permanente Neurology (J.K.), Walnut Creek, CA.
Jeffrey KlingmanMS Center, Department of Neurology (J.M.G., B.A.C.C.) and Department of Pathology (J.C., E.J.H.), University of California, San Francisco; and Kaiser Permanente Neurology (J.K.), Walnut Creek, CA.
Eric J HuangMS Center, Department of Neurology (J.M.G., B.A.C.C.) and Department of Pathology (J.C., E.J.H.), University of California, San Francisco; and Kaiser Permanente Neurology (J.K.), Walnut Creek, CA.
Bruce A C CreeMS Center, Department of Neurology (J.M.G., B.A.C.C.) and Department of Pathology (J.C., E.J.H.), University of California, San Francisco; and Kaiser Permanente Neurology (J.K.), Walnut Creek, CA.
Kaiser Permanente Walnut Creek Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo describe the clinical course and neuropathology at autopsy of a patient with neuromyelitis optica (NMO) treated with alemtuzumab.

methodsCase report.

resultsA 61-year-old woman with aquaporin-4 immunoglobulin G antibody seropositive NMO had 10 clinical relapses in 4 years despite treatment with multiple immunosuppressive therapies. Alemtuzumab was administered and was redosed 15 months later. For the first 19 months after the initial alemtuzumab infusion, the patient did not experience discrete clinical relapses or have evidence of abnormally enhancing lesions on brain or spinal cord MRI. However, she experienced insidiously progressive nausea, vomiting, and vision loss, and her brain MRI revealed marked extension of cortical, subcortical, and brainstem T2/fluid-attenuated inversion recovery (FLAIR) hyperintensities. She died 20 months after the initial alemtuzumab infusion. Acute, subacute, and chronic demyelinating lesions were found at autopsy. Many of the lesions showed marked macrophage infiltration with a paucity of lymphocytes.

conclusionsFollowing alemtuzumab treatment, there appeared to be ongoing innate immune activation associated with tissue destruction that correlated with nonenhancing T2/FLAIR hyperintensities on MRI. We interpret the cessation of clinical relapses, absence of contrast-enhancing lesions, and scarcity of lymphocytes at autopsy to be indicative of suppression of adaptive immunity by alemtuzumab. This case illustrates that progressive worsening in NMO can occur as a consequence of tissue injury associated with monocytic infiltration. This observation may be relevant to multiple sclerosis (MS) as well as NMO and might explain why in previous studies of secondary progressive MS alemtuzumab did not seem to inhibit disability progression despite a dramatic decline in contrast-enhancing lesions.

Identifiers

PMID25340086
PMCPMC4204228
OpenAlexW2099200086

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.