Article

Journal of Clinical Immunology

, Volume 30, Issue 1, pp 99-105

First online:

B-Cell Reconstitution and BAFF After Alemtuzumab (Campath-1H) Treatment of Multiple Sclerosis

  • Sara A. J. ThompsonAffiliated withDepartment of Clinical Neurosciences, University of Cambridge Email author 
  • , Joanne L. JonesAffiliated withDepartment of Clinical Neurosciences, University of Cambridge
  • , Amanda L. CoxAffiliated withDepartment of Clinical Neurosciences, University of Cambridge
  • , D. Alastair S. CompstonAffiliated withDepartment of Clinical Neurosciences, University of Cambridge
  • , Alasdair J. ColesAffiliated withDepartment of Clinical Neurosciences, University of Cambridge

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Abstract

Introduction

Treatment with alemtuzumab is highly effective in relapsing–remitting multiple sclerosis; however, 30% of patients develop autoimmunity. Alemtuzumab (previously called Campath 1-H) induces a prolonged T-cell lymphopenia with memory cells dominating the reconstituting T-cell pool for at least 3 months.

Results

Here we show that B-cell recovery is rapid, returning to baseline by 3 months and rising to 165% of baseline by 12 months after treatment. Immature transitional 1 B cells are the predominant cell type 1 month after treatment. This coincides with a surge in serum B-cell activating factor (BAFF), which remains elevated by 33% for at least 12 months after alemtuzumab. BAFF is critical for transition to the mature naive B-cell phenotype, which dominates from 3 months after alemtuzumab. Differentiation to memory B cells is slow so there are radical and prolonged alterations to the B-cell pool after alemtuzumab.

Keywords

BAFF: B-cell activating factor B cells autoimmunity reconstitution T1 B cell: transitional type I B cell