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Monitoring B-cell repopulation after depletion therapy in neurologic patients
- Source :
- Neurology® Neuroimmunology & Neuroinflammation
- Publication Year :
- 2017
-
Abstract
- ObjectiveTo determine the factors that influence B-cell repopulation after B-cell depletion therapy in neurologic patients and derive recommendations for monitoring and dosing of patients.MethodsIn this study, we determined the association of body surface area (BSA; calculated by body weight and height with the Dubois formula), sex, pretreatment therapy, age, CSF data, and white blood cell counts with the risk and timing of B-cell repopulation, defined as 1% CD19+ cells (of total lymphocytes), following 87 B cell–depleting anti-CD20 treatment cycles of 45 neurologic patients (28 women; mean age ± SD, 44.5 ± 15.0 years).ResultsPatients with a larger BSA had a higher probability to reach 1% CD19+ cells than those with a smaller BSA (p < 0.05) following B-cell depletion therapy, although those patients had received BSA-adapted doses of rituximab (375 mg/m2). Sex, pretreatment, age, CSF data, or absolute lymphocyte and leukocyte counts during treatment did not significantly influence CD19+ B-cell recovery in the fully adjusted models. Intraindividual B-cell recovery in patients with several treatment cycles did not consistently change over time.ConclusionsB-cell repopulation after depletion therapy displays both high inter- and intra-individual variance. Our data indicate that a larger BSA is associated with faster repopulation of B cells, even when treatment is adapted to the BSA. A reason is the routinely used Dubois formula, underestimating a large BSA. In these patients, there is a need for a higher therapy dose. Because B-cell count–dependent therapy regimes are considered to reduce adverse events, B-cell monitoring will stay highly relevant. Patients' BSA should thus be determined using the Mosteller formula, and close monitoring should be done to avoid resurgent B cells and disease activity.
- Subjects :
- 0301 basic medicine
medicine.medical_specialty
Lymphocyte
Urology
CD19
Article
03 medical and health sciences
0302 clinical medicine
White blood cell
Medicine
Dosing
Adverse effect
B cell
Body surface area
biology
business.industry
030104 developmental biology
medicine.anatomical_structure
Neurology
biology.protein
Repopulation
Neurology (clinical)
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 23327812
- Volume :
- 5
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Neurology(R) neuroimmunologyneuroinflammation
- Accession number :
- edsair.doi.dedup.....6765e6cbe521148f86d3bb9024f05455