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Yokota H, Hoshida Y, Hirakawa K, Miwa T, Yamada T. Progressive multifocal leukoencephalopathy following obinutuzumab and bendamustine therapy for follicular lymphoma: case report and literature review. Acta Neurol Belg 2024:10.1007/s13760-024-02580-3. [PMID: 38801626 DOI: 10.1007/s13760-024-02580-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Hiroshi Yokota
- Department of Neurosurgery, National Hospital Organization Osaka Minami Medical Center, Osaka, Kawachinagano, Japan.
| | - Yoshihiko Hoshida
- Department of Pathology, National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Osaka, Japan
| | - Kyoko Hirakawa
- Department of Radiology, National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Osaka, Japan
| | - Takashi Miwa
- Department of Neurology, National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Osaka, Japan
| | - Tomonori Yamada
- Department of Neurosurgery, National Hospital Organization Osaka Minami Medical Center, Osaka, Kawachinagano, Japan
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Diamantopoulos PT, Kalopisis K, Tsatsou A, Efthymiou A, Giannakopoulou N, Hatzidavid S, Viniou NA. Progressive multifocal leukoencephalopathy in the context of newer therapies in hematology and review of new treatment strategies. Eur J Haematol 2022; 108:359-368. [PMID: 35100451 DOI: 10.1111/ejh.13751] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 02/07/2023]
Abstract
Progressive multifocal leukoencephalopathy (PML) is a rare, often fatal demyelinating disease of the central nervous system (CNS) caused by the reactivation of JC polyomavirus in the CNS. We present a case of a 54-year-old man with follicular lymphoma diagnosed with PML after being treated with anti-CD20 monoclonal antibody-based regimens for several years. Due to the lack of effective treatment choices for PML, the patient was treated with nivolumab, based on recent reports, but succumbed to his disease a few months after diagnosis. In this paper, we focus on reviewing the literature of PML cases correlated with newer agents used in hematology, possible factors affecting disease prognosis, as well as the available data on upcoming therapeutic options for patients with PML. Though newer promising treatments such as anti-PD1 monoclonal antibodies arise, a definitive treatment option is yet to be found. Vigilance, early detection, and prompt intervention play a crucial role in the prognosis of PML in patients with hematological malignancies.
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Affiliation(s)
- Panagiotis T Diamantopoulos
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Kalopisis
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Athina Efthymiou
- Department of Neurology, Laikon General Hospital, Athens, Greece
| | - Nefeli Giannakopoulou
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sevastianos Hatzidavid
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nora-Athina Viniou
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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3
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Darcy S, Alexander M, McCarthy A, O'Dowd S. Pembrolizumab treatment of inflammatory progressive multifocal leukoencephalopathy: a report of two cases. J Neurovirol 2021; 28:145-150. [PMID: 34874539 DOI: 10.1007/s13365-021-01028-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/03/2021] [Accepted: 11/02/2021] [Indexed: 11/25/2022]
Abstract
Progressive multifocal leukoencephalopathy (PML) is a rare but devastating neurological disease caused by reactivation of the JC virus in susceptible individuals. The illness has classically been associated with the human immunodeficiency virus (HIV) and multiple sclerosis (MS) patients who are treated with natalizumab. It is also associated with haematological malignancies, organ transplantation, autoimmune disease and immunodeficiency. Aside from natalizumab, a range of other immunomodulators including obinutuzumab and rituximab have been associated with PML. The nature of these associations is unclear due to the overall low incidence of PML associated with these drugs and the fact that most patients will have other confounding risk factors for developing the disease. There is no known effective treatment available for PML in the non-HIV, non-MS cohort. Recent case studies and series have proposed that pembrolizumab, an anti-PD-1 immune checkpoint inhibitor, may be a potentially efficacious option for these patients. We present two cases of non-HIV, non-MS patients with PML who were treated with pembrolizumab with little clinical benefit. The literature surrounding pembrolizumab use in PML is discussed, with a focus on potential indicators of successful outcomes for patients who receive this therapy.
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Affiliation(s)
- Sarah Darcy
- Department of Neurology, Tallaght University Hospital, Dublin 24, Ireland.
| | - Michael Alexander
- Department of Neurophysiology, Tallaght University Hospital, Dublin 24, Ireland
| | - Allan McCarthy
- Department of Neurology, Tallaght University Hospital, Dublin 24, Ireland
| | - Seán O'Dowd
- Department of Neurology, Tallaght University Hospital, Dublin 24, Ireland
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Turine G, London F. Obinutuzumab use complicated by progressive multifocal leukoencephalopathy in a patient with chronic lymphocytic leukemia: a case report. Acta Neurol Belg 2021; 121:781-783. [PMID: 33063195 DOI: 10.1007/s13760-020-01520-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/05/2020] [Indexed: 11/24/2022]
MESH Headings
- Aged
- Antibodies, Monoclonal, Humanized/adverse effects
- Antineoplastic Agents, Immunological/adverse effects
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnostic imaging
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukoencephalopathy, Progressive Multifocal/chemically induced
- Leukoencephalopathy, Progressive Multifocal/diagnostic imaging
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Affiliation(s)
| | - Frédéric London
- Department of Neurology, CHU UCL Namur, 1 avenue G. Thérasse, 5530, Yvoir, Belgium.
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Abstract
The risk of JC polyomavirus encephalopathy varies among biologic classes and among agents within the same class. Of currently used biologics, the highest risk is seen with natalizumab followed by rituximab. Multiple other agents have also been implicated. Drug-specific causality is difficult to establish because many patients receive multiple immunomodulatory medications concomitantly or sequentially, and have other immunocompromising factors related to their underlying disease. As use of biologic therapies continues to expand, further research is needed into pathogenesis, treatment, and prevention of JC polyomavirus encephalopathy such that risk for its development is better understood and mitigated, if not eliminated altogether.
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6
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Dunham SR, Schmidt R, Clifford DB. Treatment of Progressive Multifocal Leukoencephalopathy Using Immune Restoration. Neurotherapeutics 2020; 17:955-965. [PMID: 32166631 PMCID: PMC7641288 DOI: 10.1007/s13311-020-00848-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Progressive multifocal leukoencephalopathy (PML) is a viral disease of the brain associated with immunodeficiency, immune suppressing medications, and malignancy. In the absence of effective anti-viral therapy for the causative JC virus, immune restoration has emerged as the critical therapeutic alternative. The evolving treatment of PML (and other rare JC virus-associated neurologic syndromes) requires consideration of baseline immune functioning and comorbid diseases while selecting from a number of therapeutic options to restore an effective immune response. This review focuses on the current options for management of PML in typical situations where this disease presents, including several where immune restoration is a standard therapeutic approach such as in PML associated with HIV/AIDS and in multiple sclerosis associated with natalizumab. Other circumstances in which PML occurs including associated with primary immunodeficiencies, malignancies, and transplants present greater challenges to immune reconstitution, but emerging concepts may enhance therapeutic options for these situations. Particular attention is focused on recent experience with checkpoint inhibitors, guidance for MS drug discontinuation, and strategies to monitor and facilitate immune restoration.
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Affiliation(s)
- S Richard Dunham
- Department of Neurology, Washington University in St Louis, St. Louis, MO, USA
| | - Robert Schmidt
- Department of Pathology & Immunology, Washington University in St Louis, St. Louis, MO, USA
| | - David B Clifford
- Department of Neurology, Washington University in St Louis, St. Louis, MO, USA.
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Lucijanic M, Jaksic O. Progressive multifocal leukoencephalopathy during rituximab maintenance after rituximab and bendamustine treatment for relapsed follicular lymphoma. Ann Hematol 2020; 99:2191-2192. [PMID: 32556456 DOI: 10.1007/s00277-020-04143-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Marko Lucijanic
- Hematology Department, University hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia
| | - Ozren Jaksic
- Hematology Department, University hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia. .,School of Medicine, University of Zagreb, Zagreb, Croatia.
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Pejsa V, Lucijanic M, Vrkljan Vuk A, Stoos-Veic T, Jaksic O, Jonjic Z, Pirsic M, Prka Z, Ivic M, Fazlic Dzankic A, Mitrovic Z. Prolonged methylprednisolone premedication prior to obinutuzumab in patients with chronic lymphocytic leukemia. Leuk Lymphoma 2019; 61:934-939. [DOI: 10.1080/10428194.2019.1702182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Vlatko Pejsa
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marko Lucijanic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
| | | | - Tajana Stoos-Veic
- Department of Clinical Cytology and Cytometry, University Hospital Dubrava, Zagreb, Croatia
- Faculty of Medicine, University of Osijek, Osijek, Croatia
| | - Ozren Jaksic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zeljko Jonjic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Mario Pirsic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Zeljko Prka
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Marija Ivic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
| | | | - Zdravko Mitrovic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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