Georg Pilz1, Andrea Harrer, Peter Wipfler, Katrin Oppermann, Johann Sellner, Franz Fazekas, Eugen Trinka, Joerg Kraus. 1. From the Department of Neurology (G.P., A.H., P.W., K.O., J.S., E.T., J.K.), Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria; the Department of Neurology (J.S.), Klinikum rechts der Isar, Technische Universität München, Germany; and the Department of Neurology (F.F.), Medical University of Graz, Austria.
Abstract
OBJECTIVE: To report about a possible association between fingolimod treatment and tumefactive demyelinating lesions (TDL) as seen in a patient developing repeated TDL on continued fingolimod therapy. METHODS: We performed serial clinical and radiologic assessments and immunophenotyping of blood and CSF immune cells. We also present a literature review about recent similar cases. RESULTS: Clinical course and radiologic findings were consistent with diagnosis of TDL. Immune cell phenotyping showed pronounced shifts in the immune cell composition related to fingolimod treatment. In addition, we observed a subset of highly differentiated effector cells (CD45R0negCCR7neg) within the CD8+ T-cell population, which was about 2-fold enriched in the CSF compared to the peripheral blood. CONCLUSION: Our observations add further evidence for the development of atypical demyelinating lesions in some patients receiving fingolimod. These might be related to a treatment-associated shift in the immunopathology of specifically susceptible individuals.
OBJECTIVE: To report about a possible association between fingolimod treatment and tumefactive demyelinating lesions (TDL) as seen in a patient developing repeated TDL on continued fingolimod therapy. METHODS: We performed serial clinical and radiologic assessments and immunophenotyping of blood and CSF immune cells. We also present a literature review about recent similar cases. RESULTS: Clinical course and radiologic findings were consistent with diagnosis of TDL. Immune cell phenotyping showed pronounced shifts in the immune cell composition related to fingolimod treatment. In addition, we observed a subset of highly differentiated effector cells (CD45R0negCCR7neg) within the CD8+ T-cell population, which was about 2-fold enriched in the CSF compared to the peripheral blood. CONCLUSION: Our observations add further evidence for the development of atypical demyelinating lesions in some patients receiving fingolimod. These might be related to a treatment-associated shift in the immunopathology of specifically susceptible individuals.
Authors: Mike P Wattjes; Àlex Rovira; David Miller; Tarek A Yousry; Maria P Sormani; Maria P de Stefano; Mar Tintoré; Cristina Auger; Carmen Tur; Massimo Filippi; Maria A Rocca; Franz Fazekas; Ludwig Kappos; Chris Polman Journal: Nat Rev Neurol Date: 2015-09-15 Impact factor: 42.937
Authors: Hugh Kearney; Tucker Price; Jane Cryan; Alan Beausang; Seamus Looby; Francesca M Brett; Michael Farrell Journal: Ir J Med Sci Date: 2019-02-15 Impact factor: 1.568