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Characteristics and outcomes of progressive multifocal leukoencephalopathy in hematologic malignancies and stem cell

Diego Adrianzen Herrera1, Sabarish Ayyappan2, Sakshi Jasra1

  • 1a Department of Medical Oncology, Albert Einstein College of Medicine/Montefiore Medical Center , Bronx , NY , USA.

Leukemia & Lymphoma
|July 4, 2018
PubMed

Insights

Progressive multifocal leukoencephalopathy (PML) is a serious risk following stem-cell transplants or chemoimmunotherapy for blood cancers. Patients undergoing stem-cell transplantation generally experience better outcomes and survival rates compared to those receiving other treatments.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Hematology

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a rare but severe opportunistic infection affecting the brain.
  • It is a known complication of certain immunomodulatory therapies, particularly in patients with hematologic malignancies.
  • Understanding PML incidence and outcomes in this population is crucial for patient management.

Observation:

  • A review of 107 PML cases between 1995-2017 revealed patients undergoing stem-cell transplantation (HSCT) and those treated with monoclonal antibodies (mAbs) for hematologic malignancies.
  • HSCT recipients represented 40% of cases, as did patients with indolent lymphomas receiving mAbs.
  • PML diagnosis occurred later in HSCT recipients (10.8 months vs. 4 months).

Findings:

  • HSCT recipients showed a higher response rate to PML therapy (58% vs. 25%) and a lower mortality rate (56% vs. 88%) compared to other treatment groups.
  • Median survival was significantly longer for HSCT recipients (8 months vs. 2 months).
  • These outcome differences may be influenced by patient selection bias and immune reconstitution post-HSCT.

Implications:

  • The rising incidence of PML in hematologic malignancies, linked to increased use of mAbs and HSCT, positions this group as the second most vulnerable after HIV-infected patients.
  • Further research is essential to optimize treatment strategies and improve prognosis for PML in these immunocompromised individuals.
  • The findings highlight the need for vigilant monitoring and proactive management of PML in patients undergoing intensive therapies for blood cancers.
Keywords:
Progressive multifocal leukoencephalopathyhematologic malignanciesmonoclonal antibodiesstem cell transplantation

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