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Determinants of survival in progressive multifocal leukoencephalopathy

A Marzocchetti1, T Tompkins, D B Clifford

  • 1Division of Viral Pathogenesis, BIDMC, Harvard Medical School, Boston, MA 02215, USA.

Neurology
|November 11, 2009
PubMed
Abstract

Insights

JC virus (JCV)-specific cytotoxic T-lymphocytes (CTL) showed a trend toward improved survival in progressive multifocal leukoencephalopathy (PML) patients. Enhancing cellular immunity may benefit PML outcomes.

Area of Science:

  • Neuroimmunology
  • Virology
  • Infectious Diseases

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a severe demyelinating disease.
  • Understanding survival determinants in PML is crucial for patient management.

Purpose of the Study:

  • To investigate immunologic, virologic, and radiologic factors influencing survival in PML patients.
  • To assess the prognostic value of JC virus (JCV)-specific CD8+ cytotoxic T-lymphocytes (CTLs) in PML.

Main Methods:

  • Prospective evaluation of 60 PML patients (73% HIV+) from 2000-2007.
  • Measurement of JCV-specific CD8+ CTLs in blood.
  • Analysis of clinical outcomes, including survival rates and CD4 counts.

Main Results:

  • One-year survival was 52% for HIV+/PML and 58% for HIV- PML patients.
  • Detectable CTLs within 3 months of diagnosis correlated with higher 1-year survival (73% vs. 46%).
  • JCV DNA in urine or blood did not significantly impact survival.

Conclusions:

  • JCV-specific CTL presence trended towards longer survival in PML patients.
  • CTL response showed a more pronounced effect than CD4 count in HIV+ PML patients early on.
  • Strategies to boost cellular immune response may improve PML prognosis.

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