Clinical Scorecard: Transitioning from Marginal to Central: The Role of Marginal Zone-like B Cells as Key Targets in Multiple Sclerosis Patients Treated with Cladribine
At a Glance
Category
Detail
Condition
Multiple Sclerosis
Key Mechanisms
Role of B lymphocytes, particularly marginal zone-like memory B cells, in MS pathogenesis and treatment response.
Target Population
Persons with Multiple Sclerosis (pwMS) undergoing cladribine treatment.
Care Setting
Clinical research setting involving longitudinal monitoring of MS patients.
Key Highlights
Cladribine preferentially depletes memory B cells while sparing naïve B cells.
Marginal zone-like memory B cells exhibit a significant proinflammatory capacity.
Persistence of oligoclonal bands during remission indicates ongoing B-cell activity.
B-cell-targeted therapies have transformed MS treatment outcomes.
The study investigates B-cell subset dynamics over several years post-cladribine treatment.
Guideline-Based Recommendations
Diagnosis
Utilize serum neurofilament light chain (NfL) as a marker of neuroaxonal injury and MS disease activity.
Assess for intrathecal IgG and IgM oligoclonal bands to evaluate immune activation.
Management
Consider cladribine for its efficacy in depleting proinflammatory B-cell subsets.
Monitoring & Follow-up
Longitudinal monitoring of B-cell subsets and serum NfL levels during and after treatment.
Risks
Potential for persistent oligoclonal bands despite clinical remission.
Patient & Prescribing Data
36 persons with MS, median age 39, with varying prior disease-modifying therapy exposure.
Cladribine treatment involves two cycles over two years, with specific dosing based on body weight.
Clinical Best Practices
Monitor B-cell subset reconstitution and cytokine production post-cladribine treatment.
Evaluate the presence of oligoclonal bands as part of routine MS management.
by Marta Pirronello, Mario Picozza, Gisella Guerrera, Silvia Corbisiero, Andrea Misiti, Roberta C. Placido, Alice Verdiani, Lorenzo de Marco, Manolo Sambucci, Elena Olivieri, Daniela F. Angelini, Esmeralda Quartuccio, Luca Prosperini, Carla Tortorella, Maria C. Buscarinu, Valeria Zancan, Francesca de Masi, Marco Salvetti, Claudio Gasperini, Giovanna Borsellino, Luca Battistini
