Delayed Onset Cryptogenic Organizing Pneumonia in Alemtuzumab Treatment Patient (P14-3.004)

Abstract

<h3>Objective:</h3> NA <h3>Background:</h3> Alemtuzumab is a highly effective disease modifying therapy (DMT) for relapsing-remitting multiple sclerosis (RRMS). However, its use carries known risk of immune-mediated conditions, including autoimmune thyroid disease, nephropathies, immune thrombocytopenia, acquired hemophilia, and rheumatoid arthritis. Numerous other autoimmune-related adverse effects are rare but have also been reported. We report a case of alemtuzumab-associated cryptogenic organizing pneumonia. <h3>Design/Methods:</h3> We present a 40-year-old female who was diagnosed RRMS at age 19, in 2001. She was initially treated with interferon beta-1a and glatiramer acetate injections, but discontinued due to drug intolerance. In 2003, she received 2 cycles of alemtuzumab as part of the Ilex/Campath-1H drug trial. <h3>Results:</h3> In 2018, she was identified to have persistent perihilar ground-glass infiltrates on CT thorax in the context of developing dyspnea on exertion, pleuritic pain and productive cough. Serologies and repeated bronchoscopies were unremarkable. She underwent lung biopsy which showed evidence of cryptogenic organizing pneumonia. She was started on prednisone which improved her pulmonary symptoms and perihilar infiltrates. Unfortunately, she did not tolerate prednisone taper and developed worsening symptoms and radiographic findings on lower dose of prednisone. Due to concern for worsening lower extremity edema and obesity, she was eventually transitioned from prednisone to mycophenolate mofetil. From a RRMS standpoint, she remained relapse-free following alemtuzumab and was not treated with additional DMT. <h3>Conclusions:</h3> We present a rare, non-infectious steroid-responsive lung disorder following alemtuzumab administration. While autoimmunity is common following alemtuzumab treatment, delayed onset cryptogenic organizing pneumonia has not been reported with its use in the literature. <b>Disclosure:</b> Dr. Cheng has nothing to disclose. Dr. Lannen has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Genentech. Dr. Lannen has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for TG Therapeutics.