Progressive multifocal leukoencephalopathy in multiple myeloma
Brian W Hoeynck1, Adam D Cohen2,3, Edward A Stadtmauer2,3
1Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Abstract:
Progressive multifocal leukoencephalopathy (PML) is a rare and often fatal demyelinating disease of the central nervous system caused by reactivation of the JC virus in the context of immune suppression such as HIV, malignancy, and certain immunomodulatory medications. PML has been reported only rarely in multiple myeloma patients, and its presenting features and natural history in this population are not well known. We describe six cases of PML among multiple myeloma patients treated at our institution between 2013 and 2022, including two that developed on or shortly after treatment with recently developed BCMA-directed immunotherapies.
Insights
Progressive multifocal leukoencephalopathy (PML) is a rare JC virus reactivation. This study details six PML cases in multiple myeloma patients, including two linked to BCMA-directed immunotherapies.
Area of Science:
- Neuroimmunology
- Oncology
- Infectious Diseases
Background:
- Progressive multifocal leukoencephalopathy (PML) is a rare, fatal demyelinating CNS disease.
- JC virus reactivation causes PML, typically in immunocompromised individuals.
- PML is infrequently reported in multiple myeloma (MM) patients.
Purpose of the Study:
- To investigate the clinical presentation and natural history of PML in multiple myeloma patients.
- To identify potential associations between PML and specific MM treatments, including novel immunotherapies.
Main Methods:
- Retrospective case series analysis.
- Review of medical records for six multiple myeloma patients diagnosed with PML between 2013 and 2022.
- Analysis of treatment history, particularly recent immunotherapies like BCMA-directed agents.
Main Results:
- Six cases of PML were identified in multiple myeloma patients.
- Two cases developed PML in close temporal relation to BCMA-directed immunotherapy.
- Presents the limited but important data on PML in this specific patient population.
Conclusions:
- PML is a rare but serious complication in multiple myeloma patients.
- Emerging immunotherapies, such as BCMA-directed treatments, may be associated with PML risk.
- Further research is needed to understand PML pathogenesis and management in MM.
