Obermann Mark, Ruck Tobias, Pfeuffer Steffen, Baum Julia, Wiendl Heinz, Meuth Sven G
Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany/Departments of Neurology and Haematology, University of Duisburg-Essen, Duisburg, Germany
Department of Neurology, University of Münster, Münster, Germany.
Mult Scler. 2016 Aug;22(9):1235-41. doi: 10.1177/1352458516638558. Epub 2016 Mar 15.
We report two cases of patients with relapsing-remitting multiple sclerosis with early-onset thrombocytopenia and autoimmune thyroid disease after the first treatment course with 60-mg alemtuzumab.
Case series and review of the literature.
Both patients showed severe thrombocytopenia with platelet counts of 2 × 10(9) and 11 × 10(9)/L, respectively, as well as increased thyroid antibodies within only a few months after initiating alemtuzumab treatment (11 and 9 months). Both patients responded considerably well to medical therapy including corticosteroids and intravenous immunoglobulins with slow platelet recovery over several weeks. Interestingly, both patients were previously treated with fingolimod and showed a marked lymphocytopenia that led to discontinuation.
These cases emphasize the necessity of careful clinical surveillance and proper education of patients treated with alemtuzumab as proposed by the safety-monitoring program. Previous severe lymphocytopenia under therapy with other disease-modifying therapies may be a risk factor for the development of immune thrombocytopenia.
我们报告两例复发缓解型多发性硬化症患者，在接受60毫克阿仑单抗的首个疗程治疗后，出现了早发性血小板减少症和自身免疫性甲状腺疾病。
病例系列及文献回顾。
两名患者均出现严重血小板减少，血小板计数分别为2×10⁹/L和11×10⁹/L，且在开始阿仑单抗治疗后的短短几个月内（分别为11个月和9个月）甲状腺抗体升高。两名患者对包括皮质类固醇和静脉注射免疫球蛋白在内的药物治疗反应良好，血小板在数周内缓慢恢复。有趣的是，两名患者此前均接受过芬戈莫德治疗，并出现明显的淋巴细胞减少，导致停药。
这些病例强调了按照安全监测计划对接受阿仑单抗治疗的患者进行仔细临床监测和适当教育的必要性。既往在接受其他疾病修正治疗时出现严重淋巴细胞减少可能是发生免疫性血小板减少的危险因素。
