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Progressive multifocal leukoencephalopathy in multiple myeloma. A literature review and lessons to learn
1NHS Fife, Haematology, Victoria Hospital, Kirkcaldy, KY2 5AH, UK. Ioannis.koutsavlis@nhs.net.
Abstract:
Progressive multifocal leukoencephalopathy (PML) is a rare opportunistic infection with high mortality rate usually seen in the context of immunosuppression. Although cases have been reported largely in patients with HIV/AIDS, following the use of monoclonal antibodies and occasionally in haematological malignancies, there is no review to date of patients with smouldering or treated myeloma who developed PML. Here, we conducted a literature search of PML cases in patients with multiple myeloma (MM), analyse patient and disease characteristics and describe the possible mechanisms that could lead to the development of PML. The lack of data and case reports until 2010 may indicate that PML in MM is underdiagnosed. Simultaneously, with an expanding field of new therapeutic options, patients with MM live longer, albeit continually immunosuppressed, and at risk of opportunistic infections. Emerging new treatments for PML in the horizon render the need to look out for this complication mandatory, and more case reports are needed to enrich our knowledge in this field.
Insights
Progressive multifocal leukoencephalopathy (PML) is a rare, fatal infection. This review highlights PML cases in multiple myeloma (MM) patients, suggesting it may be underdiagnosed and requires increased vigilance due to new treatments.
Area of Science:
- Neuroimmunology
- Oncology
- Infectious Diseases
Background:
- Progressive multifocal leukoencephalopathy (PML) is a rare opportunistic infection with high mortality.
- PML is typically associated with immunosuppression, including HIV/AIDS, monoclonal antibody use, and hematological malignancies.
- No comprehensive review exists for PML in smoldering or treated multiple myeloma (MM).
Purpose of the Study:
- To review and analyze cases of PML in patients with multiple myeloma (MM).
- To investigate patient and disease characteristics associated with PML in MM.
- To explore potential mechanisms leading to PML development in MM patients.
Main Methods:
- Literature search for PML cases in patients with multiple myeloma (MM).
- Analysis of patient demographics, disease characteristics, and treatment history.
- Review of potential etiological factors and pathogenetic mechanisms.
Main Results:
- Limited data suggests PML in MM may be underdiagnosed, particularly before 2010.
- MM patients are at increased risk of opportunistic infections due to prolonged immunosuppression from treatments.
- Emerging therapies for PML necessitate increased awareness and reporting of this complication.
Conclusions:
- PML is a significant, potentially underrecognized complication in multiple myeloma.
- Longer survival in MM patients, coupled with ongoing immunosuppression, increases PML risk.
- Further case reports are crucial for understanding PML in MM and guiding future management.
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