Acquired hemophilia A and other autoimmune diseases after alemtuzumab therapy for multiple sclerosis: A report of two cases

Multiple Sclerosis and Related Disorders
Elizabeth R Comini-FrotaPaulo Pereira Christo

Abstract

Alemtuzumab (ALZ) is an anti-CD52 monoclonal antibody used to treat recurrent remittent multiple sclerosis (RRMS). After ALZ infusion, there is a depletion of T and B cells expressing CD52, while the stem cells and innate immune cells are spared. Longitudinal studies with long periods of follow-ups have reported ALZ-associated autoimmune diseases, such as thrombocytopenic purpura and thyroiditis. We report two patients who developed autoimmune hemophilia A or acquired hemophilia (AHA) after ALZ infusion, one of whom developed severe vitiligo. To the best of our knowledge, these two cases of ALZ-associated AHA are the first two cases to be reported in Brazil, and the fourth and fifth AHA cases to be reported worldwide. AHA is a potential life-threatening disease if not diagnosed and treated in a timely manner. The development of AHA should be cited as a possible adverse event, and specific coagulation tests must be part of the official recommendations for patient follow-ups.

References

May 23, 2014·Journal of Neurology, Neurosurgery, and Psychiatry·Orla TuohyAlasdair Coles
Oct 14, 2014·Autoimmunity Reviews·Mitesh DwivediRasheedunnisa Begum
Sep 17, 2015·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·N GrigoriadisUNKNOWN ParadigMS Group
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Citations

Mar 2, 2021·Seminars in Thrombosis and Hemostasis·Jecko Thachil
Oct 26, 2021·Frontiers in Immunology·Paulette Esperanza Walo-DelgadoLuisa Maria Villar

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