Pembrolizumab Treatment for Progressive Multifocal Leukoencephalopathy

• Published in: The New England journal of medicine Vol. 380; no. 17; pp. 1597 - 1605
• Main Authors: Cortese, Irene, Muranski, Pawel, Enose-Akahata, Yoshimi, Ha, Seung-Kwon, Smith, Bryan, Monaco, MariaChiara, Ryschkewitsch, Caroline, Major, Eugene O, Ohayon, Joan, Schindler, Matthew K, Beck, Erin, Reoma, Lauren B, Jacobson, Steve, Reich, Daniel S, Nath, Avindra
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 25.04.2019
• Subjects: Adult; Aged; Antibodies, Monoclonal, Humanized - therapeutic use; Antigens; Antiviral drugs; Apoptosis; Body weight; Brain - diagnostic imaging; CD4 antigen; CD4-Positive T-Lymphocytes - physiology; CD8 antigen; CD8-Positive T-Lymphocytes - physiology; Cell death; Cerebrospinal fluid; Cerebrospinal Fluid - virology; Cytokines; Disability; Down-Regulation; Drug dosages; Encephalitis; Female; Humans; Immune checkpoint inhibitors; Immune clearance; Immune Reconstitution Inflammatory Syndrome - etiology; Immune response; Immune response (cell-mediated); Immunologic Factors - therapeutic use; Immunotherapy; Infections; JC Virus - isolation & purification; Laboratories; Leukoencephalopathy; Leukoencephalopathy, Progressive Multifocal - diagnostic imaging; Leukoencephalopathy, Progressive Multifocal - drug therapy; Leukoencephalopathy, Progressive Multifocal - immunology; Lymphocyte Count; Lymphocytes; Lymphoma; Magnetic Resonance Imaging; Male; Middle Aged; Monoclonal antibodies; NMR; Nuclear magnetic resonance; Patients; PD-1 protein; Pembrolizumab; Peripheral blood; Programmed Cell Death 1 Receptor - antagonists & inhibitors; Programmed Cell Death 1 Receptor - metabolism; Progressive multifocal leukoencephalopathy; Targeted cancer therapy; Viral infections; Viral Load; White Matter - diagnostic imaging; White Matter - pathology
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1815039

Eight patients with progressive multifocal leukoencephalopathy associated with chronic lymphocytic leukemia, HIV infection, lymphoma, or idiopathic lymphopenia received pembrolizumab. Five patients had clinical improvement or stabilization of PML, reduction in lesion size on MRI, and decreased JC viral load. Three showed no clinical benefit.