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Progressive multifocal leukoencephalopathy after CAR T therapy

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Abstract

Progressive multifocal leukoencephalopathy (PML) remains a life-threatening central nervous system infection in immunocompromised patients. Although outcomes have improved in cases that immune reconstitution is feasible with anti-retroviral therapy (ART) in HIV + patients or natalizumab removal in those with multiple sclerosis, in individuals with hematological malignancies, the prognosis is usually dismal. Anti-viral treatments have been largely ineffective, but immunotherapy-based approaches with checkpoint inhibitors and adoptive virus-specific T cells’ transfer are currently explored in clinical trials. PML has not been described as a cause of encephalopathy after CAR T therapy. We report the first case of PML 7 months after lymphodepleting chemotherapy with fludarabine/cyclophosphamide and anti-CD19-directed CAR T therapy in a patient with relapsed diffuse large B-cell lymphoma who relapsed fast after a previous autologous hematopoietic stem cell transplant. She remains alive 12 months after diagnosis with stabilization of her symptoms with a combination of therapies targeting viral replication and immunotherapy.

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Authors and Affiliations

  1. Division of Hematology and Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, US

    Konstantinos Sdrimas, Meilin Diaz-Paez & Lazaros J. Lekakis

  2. Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, US

    Jose F. Camargo

Authors
  1. Konstantinos Sdrimas
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  2. Meilin Diaz-Paez
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  3. Jose F. Camargo
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  4. Lazaros J. Lekakis
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Correspondence to Konstantinos Sdrimas.

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Sdrimas, K., Diaz-Paez, M., Camargo, J.F. et al. Progressive multifocal leukoencephalopathy after CAR T therapy. Int J Hematol 112, 118–121 (2020). https://doi.org/10.1007/s12185-020-02840-x

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  • DOI: https://doi.org/10.1007/s12185-020-02840-x

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