von Büdingen H-Christian, Bischof Antje, Eggers Erica L, Wang Shengzhi, Bevan Carolyn J, Cree Bruce A C, Henry Roland G, Hauser Stephen L
Department of Neurology Weill Institute for Neurosciences University of California San Francisco California.
Ann Clin Transl Neurol. 2016 Dec 20;4(1):46-52. doi: 10.1002/acn3.377. eCollection 2017 Jan.
A patient with relapsing multiple sclerosis (RMS) was treated with a standard immunomodulatory therapy, but due to ongoing disease activity was switched to rituximab. Relapses ceased, but secondary progressive MS (SPMS) eventually appeared, associated with new focal spinal cord white matter lesions. Cerebrospinal fluid (CSF) showed persistent oligoclonal bands (OCB) and clonally related B cells in CSF and peripheral blood. The treatment escalation approach failed to prevent evolution to SPMS, raising the question of whether initiation of B-cell depleting therapy at the time of RMS diagnosis should be tested to more effectively address the immune pathology leading to SPMS.
一名复发型多发性硬化症（RMS）患者接受了标准免疫调节治疗，但由于疾病持续活动，转而使用利妥昔单抗治疗。复发停止，但最终出现了继发进展型多发性硬化症（SPMS），伴有新的局灶性脊髓白质病变。脑脊液（CSF）显示持续存在寡克隆带（OCB），且CSF和外周血中存在克隆相关的B细胞。治疗升级方法未能阻止病情发展为SPMS，这就提出了一个问题，即在RMS诊断时启动B细胞清除疗法是否应进行试验，以更有效地解决导致SPMS的免疫病理学问题。
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