Table of Contents
ISRN Neurology
Volume 2013, Article ID 748127, 8 pages
Clinical Study

Dynamics of B-Cell Populations in CSF and Blood in Patients Treated with a Combination of Rituximab and Mitoxantrone

1St. Petersburg’s Center of MS and Autoimmune Diseases, City Hospital N31, Saint Petersburg, Russia
2Department of Rheumatology, Federal Clinical Center of Heart, Blood and Endocrinology, Saint Petersburg, Russia
3Laboratory of Autoimmune Diagnostics, Saint-Petersburg Pavlov Medical University, Saint Petersburg, Russia
4Department of Neurology, Leningrad Region Hospital, Saint Petersburg, Russia
5Neuroimmunology Group, Blizard Institute, Great Britain, UK
6Laboratory of Immunology, Pasteur Institute for Microbiology and Epidemiology, Saint Petersburg, Russia
7Department of Neurology, Saint-Petersburg Pavlov Medical University, Saint Petersburg, Russia
8Department of Neurology and Neurosurgery and Department of Microbiology and Immunology, McGill University, Montreal, QC, Canada

Received 16 July 2013; Accepted 9 August 2013

Academic Editors: R. Beschorner and R. Saponara

Copyright © 2013 Evgeniy Evdoshenko et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Mitoxantrone (MTX) and Rituximab (RTX) are successfully used for treatment of multiple sclerosis (MS) and can be combined to increase efficacy. Objective. We used MTX, RTX, and methylprednisolone in a single combined regiment and observed patients prospectively. Methods. We present results of observational pilot study of combined therapy of RTX and MTX in 28 patients with active MS. Therapeutic protocol consisted of two infusions within 14 days. First infusion was 1000 mg methylprednisolone (MP) IV, 1000 mg RTX IV, and 20 mg MTX IV. On day 14, 1000 mg MP IV and 1000 mg RTX IV were given. Patients were followed prospectively from 12 to 48 months. Results and Conclusion. There were no relapses among all 28 patients during the observation period. B-cell depletion of CD19+ and CD19+/CD27+ memory B-cell subpopulation in both compartments was confirmed in all patients at 6 months. We found a more rapid reconstitution of B cells in the CSF than in the peripheral blood and longstanding depression of CD19+CD27+ memory B-cell. Conclusion. Effectiveness of combined regimen of RTX and MTX could be related to longstanding depletion of CD19+CD27+ memory B-cell subset.