Abstract
Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease affecting the central nervous system as a result of reactivation of the John Cunningham (JC) polyomavirus and occurs almost exclusively in immunosuppressed individuals. The disease course of PML is variable but usually progressive and often fatal. Treatment is predominantly focused on immune restoration, although this is difficult to do outside of human immunodeficiency virus–associated PML. A recent case series demonstrated a potential role for programmed cell death protein 1 (PD-1) inhibitors, such as pembrolizumab, to contain and/or clear JC virus. Herein, we discuss the first reported Australian case of a 61-year-old female with PML secondary to chemoimmunotherapy demonstrating complete clearance of JC virus as well as clinical and radiological stabilisation following pembrolizumab treatment.
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References
Adrianzen Herrera D, Ayyappan S, Jasra S, Kornblum N, Derman O, Shastri A, Mantzaris I, Verma A, Braunschweig I, Janakiram M (2019) Characteristics and outcomes of progressive multifocal leukoencephalopathy in hematologic malignancies and stem cell transplant – a case series. Leuk Lymphoma 60(2):395
Anand P, Hotan GC, Vogel A, Venna N, Mateen FJ. (2019) Progressive multifocal leukoencephalopathy: a 25-year retrospective cohort study. Neurol Neuroimmunol Neuroinflamm. 6(6)
Carson K, Focosi D, Major E, Petrini M, Richey E, West D, Bennett C (2009) Monoclonal antibody-associated progressive multifocal leukoencephalopathy in patients treated with rituximab, natalizumab, and efalizumab: a review from the Research on Adverse Drug Events and Reports (RADAR) project. Lancet Oncol 10(8):816–824
Cortese I, Muranski P, Enose-Akahata Y, Ha SK, Smith B, Monaco M et al (2019) Pembrolizumab treatment for progressive multifocal leukoencephalopathy. N Engl J Med 3800:1597–1605
Gasnault J, Costagliola D, Hendel-Chavez H, Dulioust A, Pakianather S, Mazet AA, de Goer de Herve MG, Lancar R, Lascaux AS, Porte L, Delfraissy JF, Taoufik Y, for the ANRS 125 Trial Team (2011) Improved survival of HIV-1-infected patients with progressive multifocal leukoencephalopathy receiving early 5-drug combination antiretroviral therapy. PLoS One 6(6):e20967. https://doi.org/10.1371/journal.pone.0020967
Pavlovic D, Patera A, Nyberg F, Gerber M, Liu M (2015) Progressive multifocal leukoencephalopathy: current treatment options and future perspectives. Ther Adv Neurol Disord 8(6):255
Tan C, Koralnik I (2010) Beyond progressive multifocal leukoencephalopathy: expanded pathogenesis of JC virus infection in the central nervous system. Lancet Neurol 9(4):425–437
Warsch S, Hosein PJ, Morris MI, Teomete U, Benveniste R, Chapman JR, Lossos IS (2012) Progressive multifocal leukoencephalopathy following treatment with bendamustine and rituximab. Int J Hematol 96(2):274–278
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Holmes, A., Wellings, T., Walsh, O. et al. Progressive multifocal leukoencephalopathy associated with a lymphoproliferative disorder treated with pembrolizumab. J. Neurovirol. 26, 961–963 (2020). https://doi.org/10.1007/s13365-020-00899-0
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DOI: https://doi.org/10.1007/s13365-020-00899-0