Journal of neuroimmunology最新文献

Purpose: Relapse in the CNS is uncommon but often a fatal event in the patients with diffuse large B-cell lymphoma. An important management strategy consists of identifying patients in the high-risk group for CNS relapse and choosing those who will benefit from CNS prophylaxis. To evaluate rheumatoid arthritis as an additional risk factor for CNS relapse, we retrospectively examined the patients with DLBCL.

Methods: We examined 85 patients with diffuse large B-cell lymphoma, admitted to the hospital between June 2016 and May 2021 and followed up for at least three years, and investigate the background of nine patients with CNS relapse. CNS relapse was diagnosed by imaging, clinical, and histological or cytological findings. Also, we evaluated patients with a history of rheumatoid arthritis in these 85 patients. Statistical analysis was performed using Fisher's exact test (Statcel-the Useful Addin Forms on Excel-4th ed.) RESULTS: In the present study, we showed that nine of 85 patients (10.6%) developed CNS relapse. Three of nine cases with CNS relapse had none of the previously reported risks, but received low-dose methotrexate for rheumatoid arthritis. We observed a high proportion of CNS relapse among patients with diffuse large B-cell lymphoma and concomitant rheumatoid arthritis The association between CNS relapse and concomitant rheumatoid arthritis in diffuse large B-cell lymphoma was statistically significant. (CNS relapse / history of RA: +/+ 3, +/- 6, -/+ 5, -/- 71; p = 0.036), using Fisher's exact test.

Conclusions: Here we demonstrated a possible risk of rheumatoid arthritis for CNS relapse in diffuse large B-cell lymphoma. High-dose intravenous methotrexate has been increasingly used as a CNS prophylaxis instead of intrathecal methotrexate injection alone in patients with high-risk diffuse large B-cell lymphoma. However, our findings suggest that MTX re-administration in patients with rheumatoid arthritis with diffuse large B-cell lymphoma and high CNS relapse risk warrants particular caution. Clinicians should be aware of the possible risks in these patients, and careful consideration is needed.

Background: In muscle-specific kinase antibody-positive myasthenia gravis (MuSK-MG), the clinical utility of MuSK antibody levels as a biomarker for disease severity is debated, with conflicting reports on its correlation with clinical status. This study aimed to clarify this association by applying a rigorous statistical model to a longitudinal dataset followed from an immunotherapy-naïve state.

Methods: We conducted a retrospective longitudinal study on 6 patients with MuSK-MG tracked from their treatment-naïve baseline. The primary analysis used 103 data points where MuSK antibody levels and MG activities of daily living (MG-ADL) scores were available. A secondary analysis used the subset of 81 data points where total immunoglobulin G (IgG) levels were also concurrently measured. Generalized linear mixed-effects models (GLMM) were used to assess the intrapatient correlation, adjusting for interpatient variability by including a random intercept for each subject.

Results: First, the GLMM analysis of 103 data points revealed a strong positive intrapatient correlation between MuSK antibody levels and MG-ADL scores (P < 0.001). Second, in the subset analysis (n = 81), MuSK antibody levels remained positively and specifically correlated with MG-ADL scores (P = 0.002), whereas total IgG levels showed no independent correlation (P = 0.61) when included in the same model.

Conclusions: MuSK antibody level, unlike total IgG, is a specific and valuable biomarker for monitoring intrapatient disease activity and therapeutic response. These findings strongly support the utility of serial MuSK antibody monitoring within individual patients.