This patient with MS is anxious that he may have early secondary progressive MS and rituximab is failing him. He is keen to explore AHSCT. Is this appropriate?
Interesting point on brain volume loss associated with Rituximab. I was wondering why there was so little data available on PBVL for the novel CD20 depleters. Or at least it eludes me.
May I ask where we can submit our case for a potential evaluation in these case scenarios?
Hi Gavin, thanks for another really informative/interesting post. I just wondered what data are you referring to re rates of anti-Rituximab antibodies being 5-8%? I’d like to read it. Thanks!
I feel like time is not on his side, if he is eligible for the treatment but it has a cut off at 15yrs. I think I would begin the AHSCT process while I waited to see the MRI and OCB results, if he decided his other option was not safer.
Is cladribine also poor at preventing brain volume loss?
Sooo…is your thought that Cladribine, like anti-CD20s, would also be less attractive to people who are OCB-ve since it seems most of Cladribine’s positive effect is due to actions on B-cells? And what are the chances that OCB-ve folks might simply have b-cell involvement that is not the work of OCB/antibody emitting plasma cells in the CNS…meaning maybe, I dunno, memory B-cells pop-in in and out of the CNS from time to time emitting cytokines and doing some antigen presentation then bailing out thru the lymph ductwork? Thanks for any insight as I am contemplating options.
Is brain volume loss vital to counter right from diagnosis or does it become more important once initial high inflammation is controlled?
Also, do you perceive a time when AHSCT would be offered before treatment failure of prognostic markers are poor? (Or do you feel it should be?).
My best wishes to this gentleman and I so hope he gets some answers and benefits from therapy soon.
Interesting point on brain volume loss associated with Rituximab. I was wondering why there was so little data available on PBVL for the novel CD20 depleters. Or at least it eludes me.
May I ask where we can submit our case for a potential evaluation in these case scenarios?
Hi Gavin, thanks for another really informative/interesting post. I just wondered what data are you referring to re rates of anti-Rituximab antibodies being 5-8%? I’d like to read it. Thanks!
I feel like time is not on his side, if he is eligible for the treatment but it has a cut off at 15yrs. I think I would begin the AHSCT process while I waited to see the MRI and OCB results, if he decided his other option was not safer.
Is cladribine also poor at preventing brain volume loss?
Sooo…is your thought that Cladribine, like anti-CD20s, would also be less attractive to people who are OCB-ve since it seems most of Cladribine’s positive effect is due to actions on B-cells? And what are the chances that OCB-ve folks might simply have b-cell involvement that is not the work of OCB/antibody emitting plasma cells in the CNS…meaning maybe, I dunno, memory B-cells pop-in in and out of the CNS from time to time emitting cytokines and doing some antigen presentation then bailing out thru the lymph ductwork? Thanks for any insight as I am contemplating options.