First use of alemtuzumab in Balo’s concentric sclerosis: a case report

Brown, J William L; Coles, Alasdair; Jones, Joanne L.

doi:10.1177/1352458513498129

Cited by 12 publications

(5 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These treatments include rituximab, cyclophosphamide, mitoxantrone, and alemtuzumab. [77][78][79][80][81][82][83] The possible benefit in acute attacks for these agents is based on case reports or small series. The risk-tobenefit ratio should be weighed carefully before using these cytotoxic agents empirically.…”

Section: Third-line and Investigational Therapiesmentioning

confidence: 99%

Fulminant Demyelinating Diseases of the Central Nervous System

Bevan¹,

Cree²

2015

Semin Neurol

View full text Add to dashboard Cite

Fulminant demyelinating diseases of the central nervous system include acute disseminated encephalomyelitis, the related acute hemorrhagic leukoencephalitis, multiple sclerosis variants, neuromyelitis optica spectrum disorders, and idiopathic transverse myelitis. These syndromes are often managed with similar acute treatments including high-dose corticosteroids and plasmapheresis; however, long-term management varies. Although the prognosis of fulminant demyelinating disease was historically poor, outcomes today may be improved due to earlier diagnosis, rapid implementation of anti-inflammatory therapies such as high-dose corticosteroids and plasmapheresis, and improved supportive care.

show abstract

Section: Third-line and Investigational Therapiesmentioning

confidence: 99%

Fulminant Demyelinating Diseases of the Central Nervous System

Bevan¹,

Cree²

2015

Semin Neurol

View full text Add to dashboard Cite

show abstract

“…Nevertheless, the follow up of these patients in clinical cases was narrow [ 24 , 25 ]. Alemtuzumab treatment was associated with one death, further strengthening the hypothesis that the humoral responses are not prominent in BCS lesions, where innate immunity plays a central role with lipid-laden macrophages and giant multiple nuclei astrocytes predominating in BCS lesions [ 26 ]. The role of PLEX is controversial.…”

Section: Discussionmentioning

confidence: 76%

Heterogeneity of Baló’s concentric sclerosis: a study of eight cases with different therapeutic concepts

et al. 2020

View full text Add to dashboard Cite

Background Baló’s Concentric Sclerosis (BCS) is a rare heterogeneous demyelinating disease with a variety of phenotypes on Magnetic Resonance Imaging (MRI). Existing literature lacks data especially on the therapeutic approach of the disease which we intended to elucidate by means of suggesting a new possible BCS classification and introducing different therapeutic concepts based on each BCS-subgroup characteristics. Methods We present a retrospective study of eight treated patients with BCS-type lesions, emphasizing on MRI characteristics and differences on therapeutic maneuvers. Results Data analysis showed: at disease onset the BCS-type lesion was tumefactive (size ≥2 cm) in 6 patients, with a mean size of 2.7 cm (± 0.80 SD); a coexistence of MS-like plaques on brain MRI was identified in 7 patients of our cohort. The mean age was 26.3 years (±7.3 SD) at disease onset and the mean follow-up period was 56.8 months (range 9–132 months). According to radiological characteristics and response to therapies, we further categorized them into 3 subgroups: a) Group-1; BCS with or without coexisting nonspecific white matter lesions; poor response to intravenous methylprednisolone (IVMP); treated with high doses of immunosuppressive agents (4 patients), b) Group-2; BCS with typical MS lesions; good response to IVMP; treated with MS-disease modifying therapies (2 patients), c) Group-3; BCS with typical MS lesions; poor response to IVMP; treated with rituximab (2 patients). Conclusions Our study introduces a new insight regarding the categorization of BCS into three subgroups depending on radiological features at onset and during the course of the disease, in combination with the response to different immunotherapies. Immunosuppressive agents such as cyclophosphamide are usually effective in BCS. However, therapeutic alternatives like anti-CD20 monoclonal antibodies or more classical disease-modifying MS therapies can be considered when BCS has also mixed lesions similar to MS. Future studies with a larger sample size are necessary to further establish these findings, thus leading to better treatment algorithms and improved clinical outcomes.

show abstract

“…In three Cambridge cases of neuromyelitis optica, this effect was not seen, but alemtuzumab was not efficacious and indeed the disease may have been exacerbated (Azzopardi et al 2016). Alemtuzumab was not an effective treatment of one person with Balo's concentric sclerosis (Brown et al 2013).…”

Section: Clinical Scenarios Of Alemtuzumab Inefficacymentioning

confidence: 95%

Alemtuzumab as Treatment for Multiple Sclerosis

Katsavos

Coles

2018

Cold Spring Harb Perspect Med

View full text Add to dashboard Cite

Alemtuzumab, the first monoclonal antibody to be used as a therapy and the first to be humanized, was introduced into the treatment of multiple sclerosis in 1991 after its successful use in hematology, oncology, and transplantation medicine. One phase 2 and two phase 3 trials of this lymphocyte-depleting agent have established alemtuzumab's superior efficacy to interferon β-1a over the short term (2-3 years) with greater relapse rate reduction, reduced accumulation of disability, and more frequent sustained improvement in disability. Longer-term extension studies show durable effects on slowing cerebral atrophy over 6 years and maintained low relapse rates over 10 years, despite roughly half of patients not needing further dosing. Homeostatic proliferation of residual T cells after alemtuzumab-induced lymphopenia is probably responsible for its most common side effects: secondary autoimmunity 1 or 2 years after the last infusion of alemtuzumab affecting the thyroid gland (30% of patients), platelets (1%), or renal glomeruli (0.1%). With the prerequisite of patient and physician adherence to a prolonged safety-monitoring protocol, alemtuzumab offers durable high efficacy from infrequent dosing.

show abstract

First use of alemtuzumab in Balo’s concentric sclerosis: a case report

Cited by 12 publications

References 13 publications

Fulminant Demyelinating Diseases of the Central Nervous System

Fulminant Demyelinating Diseases of the Central Nervous System

Heterogeneity of Baló’s concentric sclerosis: a study of eight cases with different therapeutic concepts

Alemtuzumab as Treatment for Multiple Sclerosis

Contact Info

Product

Resources

About