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Progressive multifocal leukoencephalopathy treated with nivolumab.

Ethan Hoang1, Nancy L Bartlett2, Manu S Goyal1,3

  • 1Department of Neurology, Washington University in St. Louis, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.

Journal of Neurovirology
|March 14, 2019
PubMed
Summary

Treatment for progressive multifocal leukoencephalopathy (PML) is difficult due to the lack of JC virus antiviral therapies. A PD-1 inhibitor, nivolumab, showed promise in controlling PML in a patient with hematologic malignancy.

Keywords:
JC virusNivolumabPD-1 inhibitorPMLProgressive multifocal leukoencephalopathy

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Area of Science:

  • Neuroimmunology
  • Oncology
  • Virology

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a rare, serious brain infection caused by the JC virus.
  • JC virus infection is often associated with weakened immune systems, particularly in patients with hematologic malignancies.
  • Current PML treatment primarily relies on immune reconstitution, which is often not feasible for these patients.

Observation:

  • A case study of a patient with hematologic malignancy who developed PML.
  • The patient was treated with the PD-1 inhibitor nivolumab.
  • The treatment aimed to stimulate the patient's immune system to fight the JC virus.

Findings:

  • Nivolumab treatment led to observable immune activation in the patient.
  • This immune activation resulted in effective control of the PML.
  • The patient experienced a positive outcome, suggesting a potential new therapeutic avenue.

Implications:

  • This case suggests that PD-1 inhibitors like nivolumab may be a viable treatment option for PML.
  • Further research is warranted to explore the efficacy of checkpoint inhibitors in managing PML, especially when immune reconstitution is not possible.
  • This finding could offer hope for patients with PML and co-existing hematologic malignancies.