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The biggest concern with this agent is the emergence of new autoimmune disorders, which occur in approximately one-third of patients and can develop several years after the last dose.Reference Cossburn, Pace and Jones 44 Although the reason for this is unknown, it is speculated that it takes time for regulatory cells to return to normal.Reference Hill-Cawthorne, Button and Tuohy 45 Most autoimmune events with alemtuzumab are thyroid related and are generally mild or moderate and manageable with timely detection and treatment.Reference Dayan, Cuker and LaGanke 46 Unlike other agents with maximal lifetime exposure limits, alemtuzumab can be used beyond 2 years, as a 3-day annual treatment, in case of return of disease activity