Puthenparampil Marco, Rinaldi Francesca, Federle Lisa, Cazzola Chiara, Perini Paola, Gallo Paolo
Multiple Sclerosis Centre, Department of Neuroscience DNS, Università degli Studi di Padova, Via Giustiniani 2, 35128, Padova, Italy marco.
Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padova, Italy.
Ther Adv Neurol Disord. 2017 Nov 29;11:1756285617741056. doi: 10.1177/1756285617741056. eCollection 2018.
The cause and clinical significance of the transient decrease in platelet (PLT) count observed in relapsing remitting multiple sclerosis (RRMS) during alemtuzumab administration remain undefined. The aim of this study was to analyse the kinetics and clinical relevance of early onset thrombocytopaenia in alemtuzumab-treated RRMS.
A total of 26 patients with RRMS were included in a longitudinal study. Blood samples were collected immediately before the first alemtuzumab infusion (D0), and after 3 days (D3), 28 days (D28) and 49 days (D49). PLT, red blood cell (RC), leucocyte and lymphocyte counts, haemoglobin (Hb) concentration and haematocrit (Htc) were measured. Patients with MS were clinically evaluated every day of drug infusion and then at D28 and D49 to verify the presence of signs or symptoms suggestive of thrombocytopaenia.
PLT number significantly decreased at D3 ( < 0.005) and was associated with a decrease in RC count (: 0.53, < 0.01), Hb (: 0.42, = 0.05) and Htc (: 0.53, < 0.01). A progressive reversion of PLT number to normal values was observed at D28 and D49. A mild thrombocytopaenia was observed in 12 patients (46.2%), 8 of which (66.6%) had PLT nadir values at D3, and 4 (33.3%) at D28. No sign or symptom suggestive of thrombocytopaenia was observed. A strong correlation between pretreatment and nadir PTL counts (: 0.59, < 0.005) was observed; indeed, mild thrombocytopaenia was observed more frequently in these patients with a baseline PTL count lower than 230 × 10/L (83.3% 42.9%, < 0.05).
The early PLT decrease in alemtuzumab-treated patients is transient, mild, not associated with clinically relevant events and is probably related to the cytokine-released syndrome. Notwithstanding this, our findings suggest the opportunity for PLT monitoring during infusion and in the following 2 months, since a decrease in PLT count may occur.
在复发缓解型多发性硬化症（RRMS）患者接受阿仑单抗治疗期间观察到的血小板（PLT）计数短暂下降的原因及临床意义尚不清楚。本研究旨在分析阿仑单抗治疗的RRMS患者早期血小板减少的动力学及临床相关性。
共有26例RRMS患者纳入一项纵向研究。在首次输注阿仑单抗前即刻（D0）、3天（D3）、28天（D28）和49天（D49）采集血样。检测PLT、红细胞（RC）、白细胞和淋巴细胞计数、血红蛋白（Hb）浓度及血细胞比容（Htc）。MS患者在药物输注的每一天以及D28和D49进行临床评估，以确认是否存在提示血小板减少的体征或症状。
PLT数量在D3时显著下降（<0.005），并与RC计数下降相关（：0.53，<0.01）、Hb下降（：0.42，=0.05）和Htc下降（：0.53，<0.01）。在D28和D49观察到PLT数量逐渐恢复至正常水平。12例患者（46.2%）出现轻度血小板减少，其中8例（66.6%）在D3时PLT达到最低点，4例（33.3%）在D28时达到最低点。未观察到提示血小板减少的体征或症状。观察到治疗前与最低点PTL计数之间存在强相关性（：0.59，<0.005）；实际上，基线PTL计数低于230×10/L的患者中更频繁地观察到轻度血小板减少（83.3%对42.9%，<0.05）。
阿仑单抗治疗患者早期PLT下降是短暂、轻度的，与临床相关事件无关，可能与细胞因子释放综合征有关。尽管如此，我们的研究结果表明在输注期间及随后2个月进行PLT监测是有必要的，因为可能会出现PLT计数下降。
