Alemtuzumab, a highly effective treatment for relapsing remitting multiple sclerosis (RRMS), induces lymphopenia especially of CD4+ T cells. Here, we report the atypical CD4+ T population behaviour of two patients with persistent disease activity despite repeated alemtuzumab treatments. Whereas lymphocytes count decreased and fluctuated accordingly to alemtuzumab administration, their CD4+ cell percentage was not or just mildly affected and was slightly below the lowest normal limit already before alemtuzumab. These cases anticipate further studies aimed to investigate whether the evaluation of the CD4+ cell percentage could represent a helpful tool to address the individual clinical response to alemtuzumab.

Center for Experimental Research and Medical Studies Azienda Ospedaliera Città della Salute e della Scienza di Torino Italy

Clinical and Biological Sciences Department University of Torino San Luigi Gonzaga Hospital Orbassano Italy

Department of Neurology and Center of Clinical Neuroscience 1st Faculty of Medicine Charles University General University Hospital Czech Republic

Department of Neurology Clinical Hospital Sveti Duh Zagreb Medical Faculty University J J Strossmayer Osijek Croatia

Department of Neurology Referral Center for Autonomic Nervous System University Hospital Center University of Zagreb School of Medicine Zagreb Croatia

Multiple Sclerosis Center Department of Medical Science and Public Health University of Cagliari Italy

Multiple Sclerosis Study Center AO S Antonio Abate Gallarate Italy

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