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Jeantin L, Shor N, Coustans M, Roos-Weil D, Quintin-Roué I, Bellanger A, Le Garff-Tavernier M, Ben Jemaa R, Thabut D, Pourcher V, Weiss N. Progressive multifocal leukoencephalopathy in patients with chronic liver disease successfully treated with pembrolizumab. J Neurol 2024; 271:2119-2124. [PMID: 38143261 DOI: 10.1007/s00415-023-12163-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Lina Jeantin
- Département de Neurologie, Sorbonne Université, Médecine Intensive Réanimation à Orientation Neurologique, AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83, Boulevard de L'hôpital, 75013, Paris, France
| | - Natalia Shor
- Department of Neuroradiology, Pitié-Salpétrière University Hospital, AP-HP, 47-83 bd de L'hôpital, 75013, Paris, France
| | - Marc Coustans
- Department of Neurology, CHIC Quimper-Concarneau, 14 Avenue Yves Thépot - BP 1757, 29107, Quimper, Cedex, France
| | - Damien Roos-Weil
- Sorbonne Université, Department of Clinical Hematology, Pitié-Salpétrière University Hospital, AP-HP, 47-83 bd de L'hôpital, 75013, Paris, France
| | | | - Agnès Bellanger
- Pharmacie hospitalière, Sorbonne Université, AP-HP, Hôpital Pitié Salpêtrière, 75013, Paris, France
| | - Magali Le Garff-Tavernier
- Department of Biological Hematology, Pitié-Salpétrière University Hospital, AP-HP, 47-83 bd de L'hôpital, 75013, Paris, France
| | - Rahma Ben Jemaa
- Liver Intensive Care Unit, Hepatogastroenterology Department, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- Sorbonne Université, 75005, Paris, France
| | - Dominique Thabut
- Brain Liver Salpêtrière Study Group, Sorbonne Université, INSERM UMR_S 938, Centre de Recherche Saint-Antoine & Institute of Cardiometabolism and Nutrition (ICAN), 75013, Paris, France
- Liver Intensive Care Unit, Hepatogastroenterology Department, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- Sorbonne Université, 75005, Paris, France
| | - Valérie Pourcher
- Sorbonne Université, 75005, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié Salpêtrière, Service Des Maladies Infectieuses et Tropicales, Paris, France
| | - Nicolas Weiss
- Département de Neurologie, Sorbonne Université, Médecine Intensive Réanimation à Orientation Neurologique, AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83, Boulevard de L'hôpital, 75013, Paris, France.
- Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de Recherche Saint-Antoine, Maladies Métaboliques, Biliaires et Fibro-Inflammatoire du Foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
- Groupe de Recherche Clinique en REanimation et Soins Intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE) Sorbonne Université, Paris, France.
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2
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Jeantin L, Shor N, Pallix-Guyot M, Roos-Weil D, Bellanger A, Le Garff-Tavernier M, Papeix C, Weiss N, Pourcher V. Halting progressive multifocal leukoencephalopathy with pembrolizumab: the case of a patient with multiple sclerosis under fingolimod. J Neurol 2024; 271:729-732. [PMID: 37910249 DOI: 10.1007/s00415-023-12055-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Lina Jeantin
- Département de neurologie, unité de Médecine Intensive Réanimation à orientation neurologique, Sorbonne Université, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Natalia Shor
- Department of Neuroradiology, Sorbonne Université, AP-HP, Hôpital de la Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, Paris, France
| | - Maud Pallix-Guyot
- Department of Neurology, Orléans Hospital, 14 avenue de l'Hôpital, Orléans, France
| | - Damien Roos-Weil
- Department of Clinical Hematology, Pitié-Salpétrière University Hospital, 47-83 Bd de l'Hôpital, Paris, France
| | - Agnès Bellanger
- Département de Santé Publique, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Magali Le Garff-Tavernier
- Department of Biological Hematology, Sorbonne Université, AP-HP, Hôpital de la Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France
| | - Caroline Papeix
- Department of Neurology, Hospital Foundation Adolphe de Rothschild, 25-29 rue Manin, Paris, France
| | - Nicolas Weiss
- Département de neurologie, unité de Médecine Intensive Réanimation à orientation neurologique, Sorbonne Université, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris, France
- Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies métaboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France & Groupe de Recherche Clinique en REanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE) Sorbonne Université, Paris, France
| | - Valérie Pourcher
- Service des Maladies infectieuses et tropicales, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié Salpêtrière, Paris, France.
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3
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Fan S, Liu M, Bai L, Chen S, Hou B, Lin N, Yuan J, Mao C, Niu J, Ren H, Zhao Y, Zhang Z, Zhu Y, Peng B, Guan H. Pembrolizumab for the treatment of progressive multifocal leukoencephalopathy in China. J Neurovirol 2023; 29:692-698. [PMID: 37898569 DOI: 10.1007/s13365-023-01180-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/06/2023] [Accepted: 10/12/2023] [Indexed: 10/30/2023]
Abstract
The aim of this study is to analyze the clinical characteristics and outcomes of Chinese patients with progressive multifocal leukoencephalopathy (PML) who were treated with programmed cell death protein 1 (PD1) blockade therapies. We retrospectively analyzed patients who were admitted to our hospital between October 1, 2020, and October 1, 2022, diagnosed with PML and treated with PD1 blockade therapies. Four patients with PML who were treated with PD1 blockade therapies were identified. All patients were male, and their ages ranged from 19 to 54 years old. One patient (Case 2) exhibited mild pleocytosis, while three patients (Cases 2-4) had markedly reduced T lymphocyte cell counts prior to treatment. The time interval between symptom onset and treatment initiation ranged from six to 54 weeks. All patients received pembrolizumab treatment, with a total of two to four doses administered. Three patients who responded to pembrolizumab treatment showed clinical improvement starting around 8 weeks after the initiation of therapy. Although one patient did not show clinical improvement, they ultimately survived until the last follow-up. None of the patients in this study exhibited immune-related adverse events or immune reconstitution inflammatory syndrome. PD1 blockade appears to be a promising novel therapeutic option for PML; additional prospective studies are necessary to confirm its efficacy.
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Affiliation(s)
- Siyuan Fan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, China
| | - Mange Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, China
| | - Lin Bai
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, China
| | - Sixian Chen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, China
| | - Nan Lin
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, China
| | - Jing Yuan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, China
| | - Chenhui Mao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, China
| | - Jingwen Niu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, China
| | - Haitao Ren
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, China
| | - Yanhuan Zhao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, China
| | - Zaiqiang Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, China
| | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, China
| | - Hongzhi Guan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, China.
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4
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Lombardo-Del Toro P, Bragado-Trigo I, Arroyo P, Tena-Cucala R, Bau L, Matas E, Muñoz-Vendrell A, Simó M, Pons-Escoda A, Martínez-Yélamos A, Martínez-Yélamos S, Romero-Pinel L. Fingolimod-associated progressive multifocal leukoencephalopathy in a multiple sclerosis patient with a good response to filgrastim. J Neurol 2023; 270:5196-5200. [PMID: 37460853 DOI: 10.1007/s00415-023-11865-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 10/15/2023]
Affiliation(s)
- Paula Lombardo-Del Toro
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Irene Bragado-Trigo
- Department of Neurology, Hospital Residència Sant Camil - Consorci Sanitari Alt Penedès-Garraf, Sant Pere de Ribes, Barcelona, Spain
| | - Pablo Arroyo
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Raquel Tena-Cucala
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Bau
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elisabet Matas
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Muñoz-Vendrell
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Simó
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-Institut Català d'Oncologia L'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Pons-Escoda
- Department of Neuroradiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio Martínez-Yélamos
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Departament de Ciències Clíniques, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Sergio Martínez-Yélamos
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Departament de Ciències Clíniques, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Lucía Romero-Pinel
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
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5
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Baena-Álvarez B, Rodríguez-Jorge F, Beltrán-Corbellini Á, Cortés-Salgado A, De la Puente C, Corral Í. Progressive multifocal leukoencephalopathy, advanced ductal breast carcinoma, systemic sclerosis, and checkpoint inhibitors: a therapeutic dilemma. J Neurovirol 2022; 29:116-119. [PMID: 36348234 DOI: 10.1007/s13365-022-01103-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/19/2022] [Accepted: 10/27/2022] [Indexed: 11/10/2022]
Abstract
Progressive multifocal leukoencephalopathy (PML) is a demyelinating central nervous system disease infection by JC virus (JCV) in patients with a significant decline in cellular immunity. No specific treatment has demonstrated efficacy, and the disease progresses to death in most patients. Recent findings have shown stabilization or improvement of PML lesions after treatment with checkpoint inhibitors (CPI) based on immune reconstitution. Nevertheless, immunotherapy may specifically cause autoimmune diseases or may deteriorate pre-existing ones. We report a case of a patient under treatment for advanced ductal breast carcinoma and systemic sclerosis, who developed PML. The therapeutic approach included withdrawal of drugs with possible immunosuppressive effect and treatment with pembrolizumab. In the absence of reliable markers to predict CPIs response and a concern for an autoimmune worsening, immunotherapy was administered late in the course of the disease. Finally, she did not experience an autoimmune disease flare-up; however, pembrolizumab could not prevent disease progression. We believe that potential autoimmune complications should not delay treatment initiation with CPIs in PML.
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Affiliation(s)
- Belén Baena-Álvarez
- Neurology Department, Hospital Universitario Ramón Y Cajal, Ctra de Colmenar Km 9, 100, 28034, Madrid, Spain.
| | - Fernando Rodríguez-Jorge
- Neurology Department, Hospital Universitario Ramón Y Cajal, Ctra de Colmenar Km 9, 100, 28034, Madrid, Spain
| | - Álvaro Beltrán-Corbellini
- Neurology Department, Hospital Universitario Ramón Y Cajal, Ctra de Colmenar Km 9, 100, 28034, Madrid, Spain
| | | | - Carlos De la Puente
- Rheumatology Department, Hospital Universitario Ramón Y Cajal, Madrid, Spain
| | - Íñigo Corral
- Neurology Department, Hospital Universitario Ramón Y Cajal, Ctra de Colmenar Km 9, 100, 28034, Madrid, Spain
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6
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Baron M, Soulié C, Lavolé A, Assoumou L, Abbar B, Fouquet B, Rousseau A, Veyri M, Samri A, Makinson A, Choquet S, Mazières J, Brosseau S, Autran B, Costagliola D, Katlama C, Cadranel J, Marcelin AG, Lambotte O, Spano JP, Guihot A. Impact of Anti PD-1 Immunotherapy on HIV Reservoir and Anti-Viral Immune Responses in People Living with HIV and Cancer. Cells 2022; 11:cells11061015. [PMID: 35326466 PMCID: PMC8946896 DOI: 10.3390/cells11061015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 02/06/2023] Open
Abstract
The role of immune checkpoints (ICPs) in both anti-HIV T cell exhaustion and HIV reservoir persistence, has suggested that an HIV cure therapeutic strategy could involve ICP blockade. We studied the impact of anti-PD-1 therapy on HIV reservoirs and anti-viral immune responses in people living with HIV and treated for cancer. At several timepoints, we monitored CD4 cell counts, plasma HIV-RNA, cell associated (CA) HIV-DNA, EBV, CMV, HBV, HCV, and HHV-8 viral loads, activation markers, ICP expression and virus-specific T cells. Thirty-two patients were included, with median follow-up of 5 months. The CA HIV-DNA tended to decrease before cycle 2 (p = 0.049). Six patients exhibited a ≥0.5 log10 HIV-DNA decrease at least once. Among those, HIV-DNA became undetectable for 10 months in one patient. Overall, no significant increase in HIV-specific immunity was observed. In contrast, we detected an early increase in CTLA-4 + CD4+ T cells in all patients (p = 0.004) and a greater increase in CTLA-4+ and TIM-3 + CD8+ T cells in patients without HIV-DNA reduction compared to the others (p ≤ 0.03). Our results suggest that ICP replacement compensatory mechanisms might limit the impact of anti-PD-1 monotherapy on HIV reservoirs, and pave the way for combination ICP blockade in HIV cure strategies.
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Affiliation(s)
- Marine Baron
- INSERM U1135, CIMI, Département d’Immunologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (B.A.); (B.F.); (A.R.); (A.S.); (B.A.); (A.G.)
- Correspondence:
| | - Cathia Soulié
- INSERM UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Département de Virologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (C.S.); (A.-G.M.)
| | - Armelle Lavolé
- GRC #04 Theranoscan, Département de Pneumologie et Oncologie Thoracique, AP-HP, Hôpital Tenon, Sorbonne Université, F-75020 Paris, France; (A.L.); (J.C.)
| | - Lambert Assoumou
- INSERM UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, F-75013 Paris, France; (L.A.); (D.C.)
| | - Baptiste Abbar
- INSERM U1135, CIMI, Département d’Immunologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (B.A.); (B.F.); (A.R.); (A.S.); (B.A.); (A.G.)
| | - Baptiste Fouquet
- INSERM U1135, CIMI, Département d’Immunologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (B.A.); (B.F.); (A.R.); (A.S.); (B.A.); (A.G.)
| | - Alice Rousseau
- INSERM U1135, CIMI, Département d’Immunologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (B.A.); (B.F.); (A.R.); (A.S.); (B.A.); (A.G.)
| | - Marianne Veyri
- Département d’Oncologie Médicale, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (M.V.); (J.-P.S.)
| | - Assia Samri
- INSERM U1135, CIMI, Département d’Immunologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (B.A.); (B.F.); (A.R.); (A.S.); (B.A.); (A.G.)
| | - Alain Makinson
- INSERM U1175, Département de Maladies Infectieuses, Centre Hospitalier Universitaire de Montpellier, Université de Montpellier, F-34090 Montpellier, France;
| | - Sylvain Choquet
- Département d’Hématologie Clinique, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France;
| | - Julien Mazières
- Département de Pneumologie, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France;
| | - Solenn Brosseau
- Département de Pneumologie, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France;
| | - Brigitte Autran
- INSERM U1135, CIMI, Département d’Immunologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (B.A.); (B.F.); (A.R.); (A.S.); (B.A.); (A.G.)
| | - Dominique Costagliola
- INSERM UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, F-75013 Paris, France; (L.A.); (D.C.)
| | - Christine Katlama
- Département de Maladies Infectieuses, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France;
| | - Jacques Cadranel
- GRC #04 Theranoscan, Département de Pneumologie et Oncologie Thoracique, AP-HP, Hôpital Tenon, Sorbonne Université, F-75020 Paris, France; (A.L.); (J.C.)
| | - Anne-Geneviève Marcelin
- INSERM UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Département de Virologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (C.S.); (A.-G.M.)
| | - Olivier Lambotte
- Département d’Immunologie Clinique, AP-HP, Hôpital Bicêtre, Université Paris-Saclay, F-94270 Le Kremlin Bicêtre, France;
- INSERM, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IDMIT/IMVA-HB), UMR1184, Université Paris-Saclay, F-94270 Le Kremlin Bicêtre, France
| | - Jean-Philippe Spano
- Département d’Oncologie Médicale, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (M.V.); (J.-P.S.)
| | - Amélie Guihot
- INSERM U1135, CIMI, Département d’Immunologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (B.A.); (B.F.); (A.R.); (A.S.); (B.A.); (A.G.)
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7
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Picca A, Desjardins C, Bihan K, Weiss N, Guihot A, Nichelli L, Feuvret L, Pourcher V, Touat M, Dehais C. Progressive multifocal leukoencephalopathy after first-line radiotherapy and temozolomide for glioblastoma. Neuro Oncol 2022; 24:497-498. [PMID: 35038339 PMCID: PMC8917391 DOI: 10.1093/neuonc/noab306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Alberto Picca
- Service de Neurologie 2-Mazarin, Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix, AP-HP, Paris, France
| | - Clément Desjardins
- Service de Neurologie 2-Mazarin, Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix, AP-HP, Paris, France
| | - Kévin Bihan
- Centre Régional de Pharmacovigilance, Service de Pharmacologie, Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix, AP-HP, Paris, France
| | - Nicolas Weiss
- Département de Neurologie, Unité de Médecine Intensive Réanimation Neurologique, Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix, AP-HP, Paris, France
| | - Amélie Guihot
- Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Département d’Immunologie, Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix, AP-HP, Paris, France
| | - Lucia Nichelli
- Service de Neuroradiologie, Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix, AP-HP, Paris, France
| | - Loic Feuvret
- Service de Radiothérapie, Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix, AP-HP, Paris, France
| | - Valérie Pourcher
- Service de Maladies Infectieuses et Tropicales, Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix, AP-HP, Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Paris, France
| | - Mehdi Touat
- Service de Neurologie 2-Mazarin, Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix, AP-HP, Paris, France
| | - Caroline Dehais
- Service de Neurologie 2-Mazarin, Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix, AP-HP, Paris, France,Corresponding Author: Caroline Dehais, MD, Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, 47 Boulevard de l’Hôpital, 75013 Paris, France ()
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8
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Innovative therapeutic concepts of progressive multifocal leukoencephalopathy. J Neurol 2022; 269:2403-2413. [PMID: 34994851 PMCID: PMC8739669 DOI: 10.1007/s00415-021-10952-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 02/04/2023]
Abstract
Progressive multifocal leukoencephalopathy (PML) is an opportunistic viral disease of the brain-caused by human polyomavirus 2. It affects patients whose immune system is compromised by a corresponding underlying disease or by drugs. Patients with an underlying lymphoproliferative disease have the worst prognosis with a mortality rate of up to 90%. Several therapeutic strategies have been proposed but failed to show any benefit so far. Therefore, the primary therapeutic strategy aims to reconstitute the impaired immune system to generate an effective endogenous antiviral response. Recently, anti-PD-1 antibodies and application of allogeneic virus-specific T cells demonstrated promising effects on the outcome in individual PML patients. This article aims to provide a detailed overview of the literature with a focus on these two treatment approaches.
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Corey S, Smith BR, Cortese ICM. Promise and Challenges of Checkpoint Inhibitor Therapy for Progressive Multifocal Leukoencephalopathy in HIV. Curr HIV/AIDS Rep 2022; 19:580-591. [PMID: 36181625 PMCID: PMC9759507 DOI: 10.1007/s11904-022-00626-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Progressive multifocal leukoencephalopathy (PML) is a severe opportunistic infection that remains an important cause of morbidity and mortality in people living with HIV (PLWH). Immune checkpoint molecules are negative regulators of the immune response that have been targeted as a strategy to bolster anti-viral immunity in PML, with varied outcomes reported. While initiation and optimization of antiretroviral therapy remains the standard of care in HIV-related PML, the specific opportunities and risks for checkpoint blockade in these cases should be explored. RECENT FINDINGS As of April 15, 2022, only 5 of the 53 total published cases of PML treated with checkpoint blockade had underlying HIV infection; four of these had a favorable outcome. The risk of promoting immune reconstitution inflammatory syndrome is a major concern and underscores the importance of patient selection and monitoring. Checkpoint blockade warrants further exploration as a potentially promising option for treatment escalation in HIV-related PML.
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Affiliation(s)
- Sydney Corey
- grid.416870.c0000 0001 2177 357XExperimental Immunotherapeutics Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive, 5C103, Bethesda, MD 20892-1684 USA
| | - Bryan R. Smith
- grid.416870.c0000 0001 2177 357XSection of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD USA
| | - Irene C. M. Cortese
- grid.416870.c0000 0001 2177 357XExperimental Immunotherapeutics Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive, 5C103, Bethesda, MD 20892-1684 USA
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[Immune checkpoint inhibitors in the treatment of progressive multifocal leukoencephalopathy]. DER NERVENARZT 2021; 93:624-628. [PMID: 34586433 PMCID: PMC9200684 DOI: 10.1007/s00115-021-01194-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 12/02/2022]
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Bernard-Valnet R, Koralnik IJ, Du Pasquier R. Advances in Treatment of Progressive Multifocal Leukoencephalopathy. Ann Neurol 2021; 90:865-873. [PMID: 34405435 PMCID: PMC9291129 DOI: 10.1002/ana.26198] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 12/19/2022]
Abstract
Progressive multifocal encephalopathy (PML) is a severe demyelinating disease of the central nervous system (CNS) caused by JC virus (JCV), which occurs in immunocompromised individuals. Management of PML relies on restoration of immunity within the CNS. However, when this restoration cannot be readily achieved, PML has a grim prognosis. Innovative strategies have shown promise in promoting anti‐JCV immune responses, and include T‐cell adoptive transfer or immune checkpoint inhibitor therapies. Conversely, management of immune reconstitution inflammatory syndrome, particularly in iatrogenic PML, remains a major challenge. In this paper, we review recent development in the treatment of PML. ANN NEUROL 2021;90:865–873
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Affiliation(s)
- Raphaël Bernard-Valnet
- Service of Neurology, Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Igor J Koralnik
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Renaud Du Pasquier
- Service of Neurology, Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
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Lambert N, El Moussaoui M, Maquet P. Immune checkpoint inhibitors for progressive multifocal leukoencephalopathy: Identifying relevant outcome factors. Eur J Neurol 2021; 28:3814-3819. [PMID: 34251719 DOI: 10.1111/ene.15021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/09/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Progressive multifocal leukoencephalopathy (PML) is an infectious brain disease caused by JC virus in immunocompromised individuals. Immune checkpoint inhibitors (ICIs) recently emerged as a therapeutic hope for these patients but identification of those likely to respond to the treatment is still an unmet need. METHOD We performed a systematic PubMed search for reports of patients treated for PML using an ICI. Clinical, biological and radiological characteristics were contrasted between patients who responded to the treatment (RP) and those who did not (NRP). RESULTS Thirty-five patients were included in the present study. Twenty-one of them reportedly benefited from the treatment. Age, blood CD4+ cells count, pretreatment viral load in the cerebrospinal fluid (CSF), PML lesions localization, treatment delay since first PML symptoms, type of ICI used and immune-related adverse events (irAEs) occurrence did not significantly differ between RP and NRP. By contrast, a history of therapeutic immune suppression and the use of an immunosuppressive therapy at treatment initiation were significantly associated with a poor response. Besides, reaching an undetectable viral load in the CSF and reduction of the lesion load on magnetic resonance imaging after ICI administration was associated with a good clinical response. CONCLUSION Current data suggest that patients with PML under immunosuppressive therapy are less likely to respond to ICIs and raises the issue of the optimal management of irAEs during ICI treatment in this setting.
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Affiliation(s)
- Nicolas Lambert
- Department of Neurology, Liège University Hospital, Liège, Belgium.,GIGA-Stem Cells, Molecular Regulation of Neurogenesis, University of Liège, Liège, Belgium
| | - Majdouline El Moussaoui
- Department of General Internal Medicine and Infectious Diseases, Liège University Hospital, Liège, Belgium
| | - Pierre Maquet
- Department of Neurology, Liège University Hospital, Liège, Belgium.,GIGA-CRC in Vivo Imaging, University of Liège, Liège, Belgium
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Volk T, Warnatz K, Marks R, Urbach H, Schluh G, Strohmeier V, Rojas-Restrepo J, Grimbacher B, Rauer S. Pembrolizumab for treatment of progressive multifocal leukoencephalopathy in primary immunodeficiency and/or hematologic malignancy: a case series of five patients. J Neurol 2021; 269:973-981. [PMID: 34196768 PMCID: PMC8782776 DOI: 10.1007/s00415-021-10682-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/21/2021] [Indexed: 12/30/2022]
Abstract
Progressive multifocal leukoencephalopathy is a rare opportunistic infection of the brain by John Cunningham polyomavirus in immune-compromised patients. In cases where no overt option for immune reconstitution is available [e.g., in patients with primary immunodeficiency (PID)], the disease is lethal in the majority of patients. Immune checkpoint inhibition has been applied in recent years with mixed outcomes. We present four novel patients and the follow-up of a previously published patient suffering from progressive multifocal leukoencephalopathy (PML) due to PID and/or hematologic malignancy who were treated with the immune checkpoint inhibitor pembrolizumab. In two patients with PID, symptoms improved and stabilized. One patient died because of worsening PML another of intracranial hemorrhage which was unrelated to PML or its treatment with pembrolizumab. The fifth patient suffered from PID and died of a pre-existing immune dysregulation, possibly exacerbated by pembrolizumab. The long-term follow-up of the first patient provides support for therapeutic decisions during this therapy and is the longest published clinical course of a patient with checkpoint inhibition for PML. We conclude that pembrolizumab can control PML symptoms long term in a subgroup of patients with PID, in our cases for 21 and 36 months. However, therapy must be started early because symptoms are only partially reversible. In light of severe adverse events, application of pembrolizumab is only justified if the prognosis for the individual patient is very poor.
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Affiliation(s)
- Timo Volk
- Department of Neurology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - Klaus Warnatz
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany.,Center for Chronic Immunodeficiency (CCI), University Medical Center Freiburg, Freiburg, Germany
| | - Reinhard Marks
- Department of Hematology and Oncology, University Medical Center, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany
| | - Gisela Schluh
- Department of Neurology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - Valentina Strohmeier
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany.,Center for Chronic Immunodeficiency (CCI), University Medical Center Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Jessica Rojas-Restrepo
- Center for Chronic Immunodeficiency (CCI), University Medical Center Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany.,Institute for Immunodeficiency, University Medical Center, Medical Faculty, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.,RESIST - Cluster of Excellence 2155 to Hanover Medical School, Satellite Center, Freiburg, Germany
| | - Bodo Grimbacher
- Center for Chronic Immunodeficiency (CCI), University Medical Center Freiburg, Freiburg, Germany.,Institute for Immunodeficiency, University Medical Center, Medical Faculty, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.,RESIST - Cluster of Excellence 2155 to Hanover Medical School, Satellite Center, Freiburg, Germany.,DZIF - German Center for Infection Research, Satellite Center Freiburg, Freiburg, Germany.,CIBSS - Centre for Integrative Biological Signalling Studies, Albert-Ludwigs University, Freiburg, Germany
| | - Sebastian Rauer
- Department of Neurology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany.
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