Abstract: P1766

Type: Poster Sessions

Abstract Category: N/A

Previous studies have shown in MS patients that neurofilament light chain (NfL) levels in CSF and blood are associated with the occurrence of MRI and clinical disease activity and treatment status on group level. In this pilot study we investigated the individual NfL treatment response in 15 patients after immune reconstitution treatment with alemtuzumab (ATZ) using high frequency serum NfL (sNFL) assessment every month over an observational period up to 102 months. While EDSS, MRI and relapse activity were regularly collected, sNfL was measured using monthly serum samples on a Simoa HD-1 Analyzer.
ATZ could demonstrate its strong and long-term effects even on sNfL level in addition to its excellent clinical efficacy. Before ATZ start, sNfL was elevated in 6/15 patients (average 25.61pg/ml) and decreased quickly within first 6 months. In NEDA-3 positive patients, sNFL decreased and stayed at an individual low steady state level (average 4.83 pg/ml). Monthly sNFL assessments demonstrated low intra-individual variation during stable disease. In 3/15 patients, 2nd ATZ course was necessary to decrease sNFL. Clinical or MRI disease activity was paralleled by an increase of sNFL level (increase up to 20 fold for 3-6 months). Even patient reported symptoms that have not been classified as clinical relapse before were accompanied by sNFL increase proposing sNfL assessment to proof a relapse. Usually, sNFL increased about 1 month prior to first clinical symptoms with further increase and recovery over the following 1 to 3 months. Monthly sNfLs presented at higher values in patients with disease activity that required ATZ retreatment compared to responder patients. During 2 documented pregnancies, sNfL was low and stable whereas after birth, transient sNfL increase was seen in both patients without any signs of activity.
We present for the first time long-term high frequency sNfL assessment in an ATZ treated cohort for up to 8.5 years follow up allowing a holistic profiling on the individual patient level. sNfL can complement or even substitute the individual clinical and MRI monitoring. More long-term data regarding individual sNfL patient profiles have to be generated for different treatments before sNfL could be a key parameter for decision-making in clinical practice.
Disclosure: K. Akgün received personal compensation for from Biogen Idec, Roche, Sanofi and Merck for consulting service. T. Ziemssen received personal compensation from Biogen Idec, Bayer, Novartis, Sanofi, Teva, and Synthon for consulting services. Ziemssen received additional financial support for research activities from Bayer, Biogen Idec, Novartis, Teva, and Sanofi Aventis. H. Kitzler received personal compensation from Novartis and Biogen idec. U. Proschmann received personal compensation from Roche. N. Kretschmann and R. Haase declare no conflict of interest.