B-cell-driven relapse and anti-CD20 rescue therapy after Alemtuzumab in RRMS: case report and literature review.

ABSTRACT:

Background

Alemtuzumab is an immune reconstitution therapy (IRT) approved for highly active relapsing-remitting multiple sclerosis (RRMS). Notably, the differential reconstitution of B and T cells after alemtuzumab may trigger paradoxical B-cell-mediated inflammation and secondary autoimmunity.

Case report

We describe the case of a 44-year-old woman with RRMS who experienced a severe, steroid-resistant relapse nine months after her second alemtuzumab cycle. Lymphocyte subtyping revealed disproportionate B-cell repopulation, suggesting a B-cell-mediated immunopathogenesis. Early ocrelizumab switch resulted in rapid clinical and radiological recovery and sustained stability.

Literature review

We conducted a narrative review of early and paradoxical disease reactivation

SUBMITTER: Bruno PA 

PROVIDER: S-EPMC12825221 | biostudies-literature | 2025

REPOSITORIES: biostudies-literature