Evidence map›Paper›PMID 30373566›Full record

ArticleBMC neurology2018

A case of Alemtuzumab-induced neutropenia in multiple sclerosis in association with the expansion of large granular lymphocytes.

A G Vakrakou, D Tzanetakos, S Valsami, E Grigoriou, K Psarra, J Tzartos, M Anagnostouli, E Andreadou, M E Evangelopoulos, G Koutsis and 5 more

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

Article in BMC neurology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
1.5field-weighted citation impact, top 18% 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

7 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.

  1. Pooled it
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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

15 authors at 3 institutions in 1 country.

A G Vakrakou1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece. avakrakou@med.uoa.gr.
D Tzanetakos1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece.
S ValsamiDepartment of Blood Transfusion, Medical School of Athens, National & Kapodistrian University, Aretaieion Hospital, Athens, Greece.
E GrigoriouImmunology and Histocompatibility Department, Evangelismos Hospital, Athens, Greece.
K PsarraImmunology and Histocompatibility Department, Evangelismos Hospital, Athens, Greece.
J Tzartos1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece.
M Anagnostouli1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece.
E Andreadou1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece.
M E Evangelopoulos1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece.
G Koutsis1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece.
C Chrysovitsanou1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece.
E Gialafos1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece.
A Dimitrakopoulos1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece.
L Stefanis1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece.
C Kilidireas1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece.
Eginition Hospital · GREvangelismos Hospital · GRAretaeio Hospital · GR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlemtuzumab has been demonstrated to reduce the risks of relapse and accumulation of sustained disability in Multiple Sclerosis (MS) patients compared to β-interferon. It acts against CD52, leading primarily to lymphopenia. Recent data have shown that mild neutropenia is observed in 16% of treated MS-patients whereas severe neutropenia occurred in 0.6%. CASE PRESENTATION: Herein, we present the case of a 34-year-old woman with relapsing-remitting MS, with a history of treatment with glatiramer acetate and natalizumab, who subsequently received Alemtuzumab (12 mg / 24 h × 5 days). 70-days after the last Alemtuzumab administration, the patient displayed neutropenia (500 neutrophils/μL) with virtual absence of B-cells (0.6% of total lymphocytes), low values of CD4-T-cells (6.6%) and predominance of CD8-T-cells (48%) and NK-cells (47%); while large granular lymphocytes (LGL) predominated in the blood-smear examination. Due to prolonged neutropenia (5-days) the patient was placed on low-dose corticosteroids leading to sustained remission.

conclusionThis is the first case of a patient with relapsing-remitting MS with neutropenia two months post-Alemtuzumab, with simultaneous presence of LGL cells in the blood and a robust therapeutic response to prednisolone. We recommend testing with a complete blood count every 15 days in the first 3 months after the 1st Alemtuzumab administration and searching for large granular lymphocytes cell expansion on microscopic examination of the peripheral blood if neutropenia develops.

Indexed as

AdultAlemtuzumabAntibodies, Monoclonal, HumanizedFemaleHumansImmunologic FactorsLymphocytesMultiple Sclerosis, Relapsing-RemittingNeutropeniaAlemtuzumabAntibodies, Monoclonal, HumanizedImmunologic FactorsAlemtuzumabLarge granular cellsMultiple sclerosisNeutropenia

Identifiers

PMID30373566
PMCPMC6206708
OpenAlexW2899140676

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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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.