Table 3.
Risk of lymphopenia, threshold, and possible interventions*
| Treatment | Lymphocyte count measurement intervals | Threshold | Intervention |
|---|---|---|---|
| Alemtuzumab (Lemtrada®) | Monthly | No lymphocyte threshold (critical are: thrombocytopenia neutropenia, hemolytic anemia, and pancytopenia) |
Acyclovir prophylaxis If neutropenia, hemolytic anemia, thrombocytopenia, or pancytopenia occurs, immediate hematological consultation is recommended |
| Cladribine (Mavenclad®) | Min. every 2–3 months | < 200/mm3 | Acyclovir prophylaxis |
| Dimethyl fumarate (Tecifidera®) | 3-Monthly | < 800 (500)/mm3 | Repeat testing, consider alternative therapy in particular if lymphopenia persists for > 6 months |
| Fingolimod (Gilenya®) | At week 2 and 4 of treatment start; then 3-monthly | < 200/mm3 | Repeat testing, if confirmed, treatment suspension |
| Natalizumab (Tysabri®) | 6-Monthly | – | Lymphopenia not expected, consider hematological consultation if observed |
| Ocrelizumab (Ocrevus®) | 3-Monthly | – | Severe lymphopenia not expected, consider hematological consultation if observed; monitor IgG and IgM levels in addition, in particular if frequency of infections increase/severe infections occur |
| Rituximab (MabThera®, Truxima®, Rixathon®) | 3-Monthly | – | See ocrelizumab |
| Siponimod (Mayzent®) | At week 2 and 4 of treatment start; then 3-monthly (adapted from fingolimod, no specific recommendations in the FDA product information [47] | < 200/mm3 (in analogy to fingolimod, no specific recommendations in the FDA product information [47] | Repeat testing, if confirmed, treatment suspension (no specific recommendations in the FDA product information [47] |
| Teriflunomide (Aubagio®) | 2-Monthly within the first 6 months, then 3-monthly | < 200/mm3 | Treatment suspension |
*According to EMA product information and Qualitätshandbuch MS/NMOSD 2019 [69]