Figure 2 Clinical data and variation of sNfL levels of patients 4–6 with ATZ-treated MS Clinical data and variation of sNfL levels of patients 4–6 with.

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Figure 2 Clinical data and variation of sNfL levels of patients 4–6 with ATZ-treated MS Clinical data and variation of sNfL levels of patients 4–6 with ATZ-treated MS Clinical data and sNfL variation since starting ATZ and during follow-up are presented. Clinical data including relapse activity, MRI activity, and pretreatments are shown for the period before starting ATZ. Since ATZ initiation, a standardized monitoring scheme was performed by evaluation of relapse activity every months, 3 monthly EDSS, and cerebral MRI every 12 months. Patient 4 to 6 did receive only first and second ATZ infusion cycle. (patients 4 and 5) After the first and the second standard ATZ infusion courses, patients presented NEDA-3 status and low level of sNfL in the follow-up. In patient 4 and 5, sNfL significantly increased at selected time intervals. At these events, the patients presented acute neurologic symptoms that were not classified as acute relapses by the treating neurologist. No corticosteroid treatment was performed and symptoms resolved within weeks spontaneously. (patient 6) After ATZ, no clinical relapses appeared but ongoing disease activity was confirmed by MRI progression, which was paralleled by sNfL increase. ATZ = alemtuzumab; cMRI = cerebral magnetic resonance imaging; Gd+ = gadolinium enhancing; NEDA = no evidence of disease activity; sNfL = serum neurofilament light chain. Katja Akgün et al. Neurol Neuroimmunol Neuroinflamm 2019;6:e555 Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.