Progressive multifocal leukoencephalopathy in the context of newer therapies in hematology and review of new treatment strategies

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...

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Bibliographic Details
Published in:European journal of haematology 2022-05, Vol.108 (5), p.359-368
Main Authors: Diamantopoulos, Panagiotis T., Kalopisis, Konstantinos, Tsatsou, Aikaterini, Efthymiou, Athina, Giannakopoulou, Nefeli, Hatzidavid, Sevastianos, Viniou, Nora‐Athina
Format: Article
Language:English
Subjects:
Antibodies, Monoclonal - adverse effects
Antineoplastic Agents - therapeutic use
anti‐CD20
anti‐PD1
CD20 antigen
Central nervous system
Demyelinating diseases
Demyelination
Encephalitis
follicular lymphoma
hematological malignancy
Hematology
Humans
immunosuppressant
JC Virus
Leukoencephalopathy
Leukoencephalopathy, Progressive Multifocal - diagnosis
Leukoencephalopathy, Progressive Multifocal - etiology
Leukoencephalopathy, Progressive Multifocal - therapy
Lymphoma
Male
Middle Aged
Monoclonal antibodies
nivolumab
Nivolumab - therapeutic use
Patients
PD-1 protein
pembrolizumab
PML
Prognosis
Progressive multifocal leukoencephalopathy
targeted therapy
Vigilance
Viral infections
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Summary: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.
ISSN:0902-4441
1600-0609
DOI:10.1111/ejh.13751