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Nancy L. Monson, PhD; Petra D. Cravens, PhD; Elliot M. Frohman, MD, PhD; Kathleen Hawker, MD; Michael K. Racke, MD

Arch Neurol. 2005;62:258-264.

Background  Rituximab, an anti-CD20 monoclonal antibody that depletes CD20⁺ B cells, has demonstrated efficacy in peripheral neurological diseases. Whether this efficacy can be translated to neurological diseases of the central nervous system with possible autoimmune B-cell involvement remains unknown.

Objective  To determine the effect of rituximab on cerebrospinal fluid B cells in patients with multiple sclerosis.

Design  Four patients with primary progressive multiple sclerosis were treated with rituximab. Cerebrospinal fluid and peripheral blood B-cell subsets were identified by flow cytometry from each patient before and after rituximab treatment.

Results  The B cells in cerebrospinal fluid were not as effectively depleted as their peripheral blood counterparts. Rituximab treatment temporarily suppressed the activation state of B cells in cerebrospinal fluid. The residual B cells underwent expansion after rituximab treatment.

Conclusion  The effect(s) of rituximab on the cerebrospinal fluid B-cell compartment is limited in comparison with the effect(s) on the B cells in the periphery, but this finding will need to be confirmed in a larger group of MS patients.

Author Affiliations: Department of Neurology (Drs Monson, Cravens, Frohman, Hawker, and Racke) and Center for Immunology (Drs Monson and Racke), The University of Texas Southwestern Medical Center, Dallas.

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