Universität zu Köln

Ellwardt, Erik, Ellwardt, Lea ORCID: 0000-0001-9292-2392, Bittner, Stefan ORCID: 0000-0003-2179-3655 and Zipp, Frauke ORCID: 0000-0002-1231-1928 (2018). Monitoring B-cell repopulation after depletion therapy in neurologic patients. Neurol.-Neuroimmunol. Neuroinflammation, 5 (4). PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 2332-7812

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Abstract

Objective To 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. Methods In 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). Results Patients 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/m(2)). 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. Conclusions B-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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Ellwardt, Erik UNSPECIFIED UNSPECIFIED UNSPECIFIED Ellwardt, Lea UNSPECIFIED orcid.org/0000-0001-9292-2392 UNSPECIFIED Bittner, Stefan UNSPECIFIED orcid.org/0000-0003-2179-3655 UNSPECIFIED Zipp, Frauke UNSPECIFIED orcid.org/0000-0002-1231-1928 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-180624
DOI:	10.1212/NXI.0000000000000463
Journal or Publication Title:	Neurol.-Neuroimmunol. Neuroinflammation
Volume:	5
Number:	4
Date:	2018
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	2332-7812
Language:	English
Faculty:	Faculty of Management, Economy and Social Sciences
Divisions:	Faculty of Management, Economics and Social Sciences > Social Sciences > Sociology and Social Psychology > Department of Scociology
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language REMITTING MULTIPLE-SCLEROSIS; OPTICA SPECTRUM DISORDERS; NON-HODGKINS-LYMPHOMA; NEUROMYELITIS-OPTICA; RHEUMATOID-ARTHRITIS; RITUXIMAB; METAANALYSIS; IDEC-C2B8; EFFICACY; DOSAGE Multiple languages Clinical Neurology; Neurosciences Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/18062