Myeloid maturation arrest and severe late-onset neutropenia following ocrelizumab therapy in a patient with multiple sclerosis: A case report and review of the literature

William PH Kermode; Simon Kavanagh; Allan G Kermode

doi:10.1016/j.nerep.2021.100012

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Myeloid maturation arrest and severe late-onset neutropenia following ocrelizumab therapy in a patient with multiple sclerosis: A case report and review of the literature

Journal article

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Myeloid maturation arrest and severe late-onset neutropenia following ocrelizumab therapy in a patient with multiple sclerosis: A case report and review of the literature

William PH Kermode, Simon Kavanagh and Allan G Kermode

Neuroimmunology Reports, Vol.1, 100012

2021

DOI: https://doi.org/10.1016/j.nerep.2021.100012

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Abstract

Anti-CD20

Late-onset neutropenia

Multiple sclerosis

Neutropenia

Ocrelizumab

Background Ocrelizumab is a recombinant humanized monoclonal antibody directed against CD20, a transmembrane protein expressed on B cells and is approved in the treatment of multiple sclerosis (MS). Late-onset-neutropenia (LON) is a known complication of another anti-CD20 monoclonal antibody, rituximab, although few cases of ocrelizumab-associated LON have been reported to date. Objective Here, we describe a case of myeloid maturation arrest and severe LON secondary to ocrelizumab in a patient with multiple sclerosis. Case report A 56 year old male with long-standing multiple sclerosis presented with high grade fevers and oral mouth pain 10 weeks following his last ocrelizumab infusion. Examination was unremarkable aside from a small ulcer of the soft palate. Full blood picture demonstrated a severe neutropenia (0.2 × 109/L; reference range 2.0 – 8.0 × 109/L) with normal haemoglobin and platelet counts. Bone marrow biopsy was performed which demonstrated granulocyte maturation arrest at the promyelocyte stage. The patient responded promptly to G-CSF and intravenous antibiotics and was discharged home without further complications. The patient has had further ocrelizumab infusions without complication. Conclusion To our knowledge, this is the first documented case of myeloid maturation arrest in patients receiving ocrelizumab and adds to the current literature supporting LON as a potential adverse effect of ocrelizumab.

Details

Title: Myeloid maturation arrest and severe late-onset neutropenia following ocrelizumab therapy in a patient with multiple sclerosis: A case report and review of the literature
Authors/Creators: William PH Kermode - Sir Charles Gairdner Hospital
Simon Kavanagh - St John of God Subiaco Hospital
Allan G Kermode - Murdoch University
Publication Details: Neuroimmunology Reports, Vol.1, 100012
Publisher: Elsevier B.V.
Identifiers: 991005623568507891
Murdoch Affiliation: Institute for Immunology and Infectious Diseases
Language: English
Resource Type: Journal article

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