Progressive multifocal leukoencephalopathy: an unexpected complication of modern therapeutic monoclonal antibody therapies.

Abstract

Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disorder of the central nervous system, caused by the reactivation of the ubiquitous JC virus. PML usually occurs during severe immunosuppression, and the most common causes are represented by human immunodeficiency virus infection, lymphoproliferative disorders and other forms of cancer. Recently, the introduction of monoclonal antibodies (e.g. natalizumab, rituximab, efalizumab) in the treatment of several dysimmune diseases such as multiple sclerosis, rheumatoid arthritis, psoriasis and systemic lupus erythematosus, has led to an increased incidence of PML. This phenomenon has had severe consequences, leading, for example, to the withdrawal from the market of Efalizumab, and important restrictions in the use of the other compounds, all of which are characterized by high efficacy in improving prognosis and quality of life. In this review we will discuss clinical, laboratory and imaging findings of PML. In addition, proposed pathogenetic mechanisms promoting the reactivation of JC virus in the context of treatment with monoclonal antibodies will be described.

• Authors: E Tavazzi, P Ferrante, K Khalili
• Journal: Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases (Clin Microbiol Infect) Vol. 17 Issue 12 Pg. 1776-80 (Dec 2011) ISSN: 1469-0691 [Electronic] England
• PMID: 22082208 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Review)
• Copyright: © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.

Chemical References

• Antibodies, Monoclonal
• Immunosuppressive Agents

Topics

• Antibodies, Monoclonal (adverse effects, therapeutic use)
• Arthritis, Rheumatoid (drug therapy)
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Incidence
• Leukoencephalopathy, Progressive Multifocal (chemically induced, epidemiology, pathology)
• Lupus Erythematosus, Systemic (drug therapy)
• Multiple Sclerosis (drug therapy)
• Opportunistic Infections (chemically induced, epidemiology, pathology)
• Psoriasis (drug therapy)