Remission of early persistent cladribine-induced neutropenia after filgrastim therapy in a patient with Relapsing - Remitting Multiple Sclerosis

Maniscalco, Giorgia Teresa; Annunziata, Mario; Ranieri, Angelo; Alfieri, G; Renna, Rosaria; Iorio, Walter Di; Guarcello, G; Cerillo, Ilaria; Improta, Giovanni; Florio, Ciro

doi:10.1016/j.msard.2020.102151

Cited by 17 publications

(7 citation statements)

References 8 publications

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“…As a pulse therapy, cladribine may not be able to contain a strong inflammatory response triggered by the vaccine, leading to a relapse. On the other hand, among DMTs, cladribine is associated with a low risk of infection and severe lymphopenia ( 11 ). In addition, since systemic infections, such as COVID-19, can worsen MS, the vaccination can be able to reduce the risk of relapses by dropping the risk of infections ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

Severe Multiple Sclerosis Relapse After COVID-19 Vaccination: A Case Report

et al. 2021

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We describe a case of acute relapse in a woman with Multiple Sclerosis (MS) shortly after the mRNA COVID-19 vaccination. The patient received a diagnosis of MS in November 2016 at the MS Centre of the A. Cardarelli Hospital (South of Italy). Since that moment, her clinical conditions and pharmacological therapies have been managed at this MS centre where, according to national recommendations, in April 2021, the patient received the BNT162b2 vaccine. Almost 48 h after receiving the vaccine, the patient developed paraesthesia and weakness in her left arm and limbs. The neurological examination revealed walking difficulties while the MRI showed three new voluminous enhancing lesions. After having received methylprednisolone iv for 5 days, the patient's neurological symptoms fully recovered. Along with the implementation of COVID-19 vaccination programmes among vulnerable population, further studies are needed in order to improve our knowledge on the benefit/risk ratio of COVID-19 vaccines.

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Section: Discussionmentioning

confidence: 99%

Severe Multiple Sclerosis Relapse After COVID-19 Vaccination: A Case Report

et al. 2021

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“…Finally, four case reports concerned the occurrence of hematological disorders following treatment with cladribine ( 34 ), siponimod ( 25 ), glatiramer acetate ( 79 ) and the combined therapy IFN/glatiramer acetate ( 22 ).…”

Section: Resultsmentioning

confidence: 99%

“…The patient received ciprofloxacin for 5 days and filgrastim for 10 days with improvements in blood exams. After the second cladribine cycle, neutropenia occurred again, requesting a new cycle of ciprofloxacin and filgrastim with positive outcome ( 34 ).…”

Section: Resultsmentioning

confidence: 99%

Disease-modifying therapies and hematological disorders: a systematic review of case reports and case series

Scavone,

Liguori,

Adungba

et al. 2024

Front. Neurol.

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IntroductionDisease modifying therapies (DMTs) used to treat multiple sclerosis (MS) can be associated to the occurrence of hematological disorders. This systematic review aims to provide an overview of these events occurring in real-life conditions, by describing case reports and series published in the literature.MethodsA literature search of all publications up to January 5th 2024 on the Medline and Embase databases was carried out. The results were presented both in the text and in tables.ResultsSixty-seven case reports/series were included in this review, of which more than half related to alemtuzumab, natalizumab and ocrelizumab. The publication date of included studies ranged from 2006 to 2024. The majority of case reports and series described the occurrence of late-onset hematological disorders (events that occurred more than 30 days after the first DMT administration), mainly represented by case of neutropenia, autoimmune hemolytic anemia and immune thrombocytopenia. All cases reported a favorable outcome, apart one case report that described a fatal case. Among included cases, 4 articles, all related to natalizumab, described the occurrence of myeloid disorders in 13 newborns from mother receiving the DMT.DiscussionConsidering the limitations identified in the majority of included studies, further ad hoc studies are strongly needed to better evaluate the hematological disorders of DMTs. Meantime, the strict monitoring of treated patients for the occurrence of these toxicities should be highly recommended.

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“…The immune‐suppressive dimethyl fumarate may act to alter neutrophil function 80 . Cladribine, cyclophosphamide, and mitoxantrone, as cell cycle inhibitors, disrupt DNA synthesis of lymphocytes and other cells, and each reduces the number of neutrophils 78,81,82 . The deficiency of therapeutic drugs emphasizes further study of the role of neutrophils in MS.…”

Section: Othersmentioning

confidence: 99%

The emerging role of neutrophils in autoimmune‐associated disorders: effector, predictor, and therapeutic targets

Liu

Huang

et al. 2021

MedComm

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Neutrophils are essential components of the immune system and have vital roles in the pathogenesis of autoimmune disorders. As effector cells, neutrophils promote autoimmune disease by releasing cytokines and chemokines cascades that accompany inflammation, neutrophil extracellular traps (NETs) regulating immune responses through cell–cell interactions. More recent evidence has extended functions of neutrophils. Accumulating evidence implicated neutrophils contribute to tissue damage during a broad range of disorders, involving rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), primary sjögren's syndrome (pSS), multiple sclerosis (MS), crohn's disease (CD), and gout. A variety of studies have reported on the functional role of neutrophils as therapeutic targets in autoimmune diseases. However, challenges and controversies in the field remain. Enhancing our understanding of neutrophils’ role in autoimmune disorders may further advance the development of new therapeutic approaches.

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Remission of early persistent cladribine-induced neutropenia after filgrastim therapy in a patient with Relapsing - Remitting Multiple Sclerosis

Cited by 17 publications

References 8 publications

Severe Multiple Sclerosis Relapse After COVID-19 Vaccination: A Case Report

Severe Multiple Sclerosis Relapse After COVID-19 Vaccination: A Case Report

Disease-modifying therapies and hematological disorders: a systematic review of case reports and case series

The emerging role of neutrophils in autoimmune‐associated disorders: effector, predictor, and therapeutic targets

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