AUTHOR=Rabaneda-Lombarte Neus , Teniente-Serra Aina , Massuet-Vilamajó Anna , Ramo-Tello Cristina , Presas-Rodríguez Silvia 

TITLE=Case report: tumefactive demyelinating lesions after the second cycle of alemtuzumab in multiple sclerosis; immune cell profile and biomarkers

JOURNAL=Frontiers in Immunology

VOLUME=15

YEAR=2024

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2024.1395749

DOI=10.3389/fimmu.2024.1395749

ISSN=1664-3224

ABSTRACT=<sec><title>Objective</title><p>We present a case of multiple tumefactive demyelinating lesions (TDLs) emerging 24 months after the second cycle of alemtuzumab treatment.</p></sec><sec><title>Methods</title><p>A woman with relapsing-remitting multiple sclerosis (MS) discontinued fingolimod treatment due to gestational desire, which resulted in a severe disease exacerbation. Alemtuzumab was initiated, accompanied by regular clinical, radiological, and immunological monitoring.</p></sec><sec><title>Results</title><p>She relapsed prior to the second cycle, exhibiting 12 T1Gd<sup>+</sup> lesions, and peripheral blood showed an increase in B-cells and a decrease in T-cells. At 24 months following the second cycle, she developed cognitive impairment and multiple T1Gd<sup>+</sup> lesions, including TDLs, were evident on the brain MRI. We found not only an increase in B-cells but also in Th1 central memory cells. Th1/Th17 cells increased 3 months before the detection of TDLs.</p></sec><sec><title>Conclusions</title><p>TDLs can appear 24 months after the second cycle of alemtuzumab treatment in MS. The increase in Th1/Th17 cells could be a candidate biomarker for TDLs in alemtuzumab-treated MS patients.</p></sec>