Diffuse alveolar hemorrhage as an early complication of alemtuzumab treatment: A case report of a multiple sclerosis patient and an overview of 14 cases

B R H Drop; D Zemel; B H A Wokke; B W van Oosten; S Dik; C O Martins Jarnalo; P E Westerweel; J W K de Beukelaar

doi:10.1016/j.msard.2020.102614

Diffuse alveolar hemorrhage as an early complication of alemtuzumab treatment: A case report of a multiple sclerosis patient and an overview of 14 cases

Mult Scler Relat Disord. 2021 Jan:47:102614. doi: 10.1016/j.msard.2020.102614. Epub 2020 Nov 16.

Authors

B R H Drop¹, D Zemel¹, B H A Wokke², B W van Oosten³, S Dik⁴, C O Martins Jarnalo⁵, P E Westerweel⁶, J W K de Beukelaar⁷

Affiliations

¹ Department of Neurology, Albert Schweitzer hospital, post office box 444, 3300AK, Dordrecht, Netherlands.
² Department of Neurology, Erasmus Medical Center, post office box 2040, 3000CA, Rotterdam, Netherlands.
³ Department of Neurology, Amsterdam UMC, location VUmc, post office box 7057, 1007 MB, Amsterdam, Netherlands.
⁴ Department of Pulmonology, Albert Schweitzer hospital, post office box 444, 3300AK, Dordrecht, Netherlands.
⁵ Department of Radiology, Albert Schweitzer hospital, post office box 444, 3300AK, Dordrecht, Netherlands.
⁶ Department of Hematology, Albert Schweitzer hospital, post office box 444, 3300AK, Dordrecht, Netherlands.
⁷ Department of Neurology, Albert Schweitzer hospital, post office box 444, 3300AK, Dordrecht, Netherlands. Electronic address: beukelaarj@asz.nl.

PMID: 33249378
DOI: 10.1016/j.msard.2020.102614

Abstract

Alemtuzumab is effective in relapsing remitting multiple sclerosis (RRMS). Serious adverse events have led to a renewed safety reassessment by the European Medicines Agency (EMA), leading to an approval under strict conditions. We report a RRMS patient experiencing diffuse alveolar hemorrhage (DAH) on day 4 of her first alemtuzumab cycle. In addition, we present an overview of the cases of alemtuzumab-induced DAH that were included in EMA's review procedure, additional well documented cases reported to the EMA and those cases reported in the literature. Combining these cases revealed striking similarities. Importantly, DAH was an early complication. All RRMS patients with known outcome showed complete recovery.

Keywords: Adverse events; Alemtuzumab; Diffuse alveolar hemorrhage; Hemoptysis; Multiple sclerosis; Respiratory symptoms.

Publication types

Case Reports
Letter

MeSH terms

Alemtuzumab / adverse effects
Female
Hemorrhage / chemically induced
Humans
Lung Diseases*
Multiple Sclerosis*
Multiple Sclerosis, Relapsing-Remitting* / drug therapy

Substances

Alemtuzumab