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Abstract Details

Rapid onset drug induced neutropenia associated with Ocrelizumab in Multiple Sclerosis
Multiple Sclerosis
P6 - Poster Session 6 (12:00 PM-1:00 PM)
9-020

Ocrelizumab, is a humanized monoclonal antibody used for treatment of relapsing and primary progressive multiple sclerosis (MS). In the primary progressive clinical trial, ocrelizumab was shown to decrease the neutrophil counts in 13% of patients compared to 10% in placebo patients. Severe neutropenia (ANC of <0.5) is a rare complication in ocrelizumab patients.  Late-onset-neutropenia (LON) is a known complication of an analogue of ocrelizumab, Rituximab, and is defined as an absolute neutrophil count (ANC) of <1.5 × 109/L occurring >4 weeks from last infusion. Rapid onset neutropenia may also be drug induced.

Here we report a recent case of rapid onset drug induced neutropenia occurring one day after repeat administration of ocrelizumab, seen in the setting of fever, and treated with granulocyte colony stimulating factor (GCSF).

A 43-year-old female with a 20-year history of relapsing remitting MS who received a repeat dose of ocrelizumab one day prior, presented to our ED with a low grade fever. Ocrelizumab had been started 18 months prior, and prior immunotherapies included interferon beta-1a, and natalizumab. Admission labs revealed neutropenia (neutrophil count of zero) and review of records indicated a normal WBC including neutrophil count several days prior. Peripheral smear showed leukopenia with severe neutropenia, few reactive lymphocytes and no blasts. Bone marrow biopsy showed trilineage hematopoiesis consisting of normoblastic erythroids, adequate megakaryocytes and myeloids demonstrating maturation up to band stage, with very rare mature neutrophils. Viral studies including Hepatitis, EBV, CMV, Parvovirus, andInfluenza were negative. Vitamin B12, folate, LDH, haptoglobin and fibrinogen levels were normal. One dose of GCSF was given and her ANC rapidly improved to normal. Emperic antibiotics were given.

N/A

We encountered a case of rapid onset drug induced neutropenia in an ocrelizumab treated patient.

Authors/Disclosures
Varun Kumar Pala, MD (Neurocare of the South)
PRESENTER
Dr. Pala has nothing to disclose.
Bahareh Sianati, MD (Allegheny General Hospital - Neurology) No disclosure on file
Thomas F. Scott, MD (Allegheny Neurological Assoc) Dr. Scott has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Scott has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genzyme. Dr. Scott has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Serono. Dr. Scott has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Biogen. Dr. Scott has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Novartis. Dr. Scott has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Scott has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genzyme. Dr. Scott has received research support from Biogen. Dr. Scott has received research support from Novartis.