Copyright
©The Author(s) 2015.
World J Neurol. Mar 28, 2015; 5(1): 39-46
Published online Mar 28, 2015. doi: 10.5316/wjn.v5.i1.39
Published online Mar 28, 2015. doi: 10.5316/wjn.v5.i1.39
Table 2 Monitoring parameters in Neuromyelitis optica patients treated with rituximab
Ref. | Monitoring parameter/comments |
Cree et al[20] | CD19 levels- when detectable, patients were re-treated. CD 19 followed bimonthly. 2 protocols-planned infusions every 6 mo or 12 mo |
Jacob et al[23] | CD19 not routinely monitored. Some RTX given when B-cell counts detectable either 6 or 12 mo in intervals or when CD19+ became detectable |
Bomprezzi et al[31] | Flow cytometry used to test circulating B cells. Suggest clinical relapses occurring while on RTX therapy correlate with reconstitution of circulating B cells. Correlated that even early rise in CD20+ cells correlated with radiologically proven relapses. B cells had re-sent between 2% and 12% at time of new attack. Total of 7 patients relapsed after RTX-5 had acute event when B cell counts just returned to greater than 1%, whereas 2 patients continued to relapse despite B cells being undetectable. Detected significant variability in timing of reconstitution of normal values, which implies that scheduling of doses of RTX can be adjusted accordingly |
Bedi et al[24] | CD19 cell counts planned every 2-3 mo, but not collected systematically for report |
Pellkofer et al[30] | Measured lymphocyte subsets by flow cytometry; B cell depletion defined as counts below 0.01 × 109 /L. B cells became undetectable in 9 out of 10 patients within 14 d after 1st dose. Time of B-cell repopulation varied. After 3 patients experienced a relapse shortly after reappearance of B cells, RTX given at fixed interval every 6 to 9 mo, which this led to improved outcomes |
Javed et al[22] | “Non-responders” were defined as clinical attack < 6 mo post rituximab treatment, when B cell count was still undetectable |
Gredler et al[26] | Flow cytometry used; B cells quantified using following combinations of monoclonal antibodies: CD3/19/45, 19/27/45, 19/38/45. Two patients out of 6 had relapses while B-cells were absent |
Lindsey et al[32] | 4 patients had relapses after more than 1 mo when peripheral B cell count “very low”. Case 1: CD19 increased to 250 cells/µL had sensory relapse, no further symptoms for 18 mo; Case 2: Had relapses with CD19 count of 0; Case 3, 4, 6 no further relapses; Case 5: CD19 1 cells/µL at 10 mo, 12 cells/µL at 13 mo and subsequent relapses; Case 7--continued to have relapses with 1 cell/µL at 7 mo, 4 cells/µL at 12 mo. Case 8: CD19 count 3 cells/µL, with continued relapses; Case 9: continued relapses with CD19 1 cells/µL |
Kim et al[27] | Blood samples obtained every 6 wk in 1st year, every 8 wk in second year. Therapeutic target for CD 27+ memory B cell depletion was less than 0.05% of PBMCs. Patients received additional infusion of 375 mg/m2 if frequency of re-emerging memory CD27+ B cells in PBMCs exceeded 0.1% by flow cytometry. CD 19 B cells counts measure- less than 0.01 × 109 /L or less than 0.5% of PBMCs (considered B cell depletion in prior studies. 60%-65% relapses occurred when CD19 were depleted. Authors argue CD27+ more informative biomarker than CD19 |
Yang et al[28] | Goal of CD19+ B cells to less than or equal to 1%, as well as CD19 CD27 B cells to less than or equal to 0.05% of PBMCs. All with no relapses despite low doses of RTX (100 mg single infusion and follow up infusion at mean of 35 wk) |
Mealy et al[29] | CD19 cell counts tested monthly, repeated dosing scheduled on detection of CD19 greater than 1% of total lymphocyte population or at regular 6 mo intervals |
Farber et al[21] | Total of 23 relapses, of which 70% occurred when B cells < 1% of lymphocytes. 7 relapses (30%) occurred when B cells greater or equal to 1% of lymphocytes. CD19 > 1% was associated with higher rate of relapses |
- Citation: Wong E, Vishwanath VA, Kister I. Rituximab in neuromyelitis optica: A review of literature. World J Neurol 2015; 5(1): 39-46
- URL: https://www.wjgnet.com/2218-6212/full/v5/i1/39.htm
- DOI: https://dx.doi.org/10.5316/wjn.v5.i1.39