Clinical impact of B-cell depletion with the anti-CD20 antibody rituximab in chronic fatigue syndrome: A preliminary case series
Fluge O et al. – Observations suggest that B-lymphocytes are involved in chronic fatigue syndrome (CFS) pathogenesis for a subset of patients. Benefit for all CFS symptoms, the delayed symptom relief following B-cell depletion, the kinetics of relapses, and the effect also from methotrexate treatment, provide suggestive evidence that B-cells play a significant role in the ongoing clinical features, and that CFS may be amenable to therapeutic interventions aimed at modifying B-cell number and function. Methods- Basis for this case series was the observation that a patient with CFS had unexpected, marked recovery of CFS symptoms lasting for 5 months during and after cytotoxic chemotherapy for Hodgkin's disease
- Postulation was that the transient recovery could be related to MTX treatment, which induces immunomodulation in part through B-cell depletion
- In a case series this patient and 2 additional CFS pts were B-cell depleted by infusion of the monoclonal anti-CD20 antibody rituximab
Results- All 3 had improvement of all CFS symptoms
- Patients 1 and 2 had major amelioration from 6 wks after intervention, patient 3 slight improvement from the same time, but then improved markedly from 26 wks after intervention
- Symptomatic effect lasted until wks 16, 18 and 44, respectively
- At relapse, all were retreated with a single (patient 1) or double rituximab infusion (patients 2 and 3)
- Again, all 3 had marked symptom improvement, mimicking their first response
- After new symptom recurrence, pts 1 and 2 were given weekly oral MTX, patient 1 having effect also from this agent
- Pts 1 and 2 were again treated for a third rituximab infusion after new relapse, again with a marked clinical benefit
- No unexpected toxicity was seen
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