Musa ÖZTÜRK, Rabia Gökçen GÖZÜBATIK ÇELİK, Fulya BAŞOĞLU KOSEAHMET

Doz Alemtuzumab Tedavisinde Ciddi Karaciğer Enzim Yüksekliği

AMAÇ: Multipl Sklerozda (MS) monoklonal antikorlar gibi birçok yeni tedavi vardır. Bu olgu ile Alemtuzumab tedavisinin önemli bir yan etkisini bildirmeyi amaçladık. OLGU: 32 yaşında kadın MS hastası alemtuzumab infüzyonu aldı. İlk doz sonrası yapılan kan testlerinde hayati tehlikeye neden olabilen karaciğer enzimlerinde 17 kat artış tespit edildi. Bu durum geçici hücre aktivasyonundan ve İnfüzyonla İlişkili Reaksiyonlardan (IAR'ler) kaynaklandığı düşünüldü. SONUÇLAR: Monoklonal antikor tedavilerinin yan etkileri bilinmekle birlikte bu durumun fatal olabileceği her zaman akılda tutulmalı, gerekli önlemler alınmalıdır

Anahtar Kelimeler:

Multiple-sclerosis, Alemtuzumab, significant side effect, hypertransaminasemia

Significant Infusion-associated reaction during first dose Alemtuzumab Treatment

There are many new treatments in Multiple Sclerosis (MS), such as monoclonal antibodies. We aimed to report the expected but crucial side effects of alemtuzumab treatment for the first time. A 32 years old female with MS had been received alemtuzumab; after therapy, 17-times increase of liver enzymes called fatal level was detected in blood tests. It could be caused by transient cell activation and infusion associated reactions (IARs). The side effects of monoclonal antibody treatments can be fatal to the patient, even if known.

Keywords:

Multiple-sclerosis, Alemtuzumab, Side effect, Hypertransaminasemia,

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(1) Havla J, Warnke C, Derfuss T, Kappos L, Hartung H-P, Hohlfeld R. Interdisciplinary Risk Management in the Treatment of Multiple Sclerosis. Deutsches Ärzteblatt International, 2016;13(51-52):879-86. https://doi: 10.3238/arztebl.2016.0879.
(2) Al-Sawaf O, Fischer K, Herling CD, Ritgen M, Böttcher S, Bahlo J et al. Alemtuzumab consolidation in chronic lymphocytic leukaemia: a phase I/II multicentre trial. Eur J Haematol, 2017; 98(3):254-62. https://doi: 10.1111/ejh.12825.
(3) Thomas K, Eisele J, Rodriguez-Lea FA, Hainke U, Ziemssen T. Acute effects of alemtuzumab infusion in patients with active relapsing-remitting MS. Neurol Neuroimmunol Neuroinflamm, 2016; 3(3): e228. https://doi: 10.1212/NXI.0000000000000228
(4) Sandra Vukusic S, Brassat D, Seze J, Izquierdo G, Lysandropoulos A, Moll W, Vanopdenbosch L, Arque MJ, Kertous M, Rufi P, Oreja-Guevara C. Single-Arm Study to Assess Comprehensive Infusion Guidance for the Prevention and Management of the Infusion Associated Reactions (IARs) in Relapsing-Remitting Multiple Sclerosis (RRMS) Patients Treated With Alemtuzumab (EMERALD) Mult Scler. Relat. Disord. 2019; 29:7-14 doi: https://doi.org/10.1016/j.msard.2019.01.019
(5) Lee DW, Gardner R, Porter DL, Louis CU, Ahmed N, Jensen M et al. Current concepts in the diagnosis and management of cytokine release syndrome. Blood, 2014;10:124(2):188-5. https://doi: 10.1182/blood-2014-05-552729.