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Progressive multifocal leukoencephalopathy in a patient with multiple myeloma: a case report and analysis of the FDA
Elise Jonasson1, Ronald Antulov2,3, Per Trøllund Pedersen1
1Department of Hematology, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark.
Abstract:
This paper demonstrates a case of progressive multifocal leukoencephalopathy (PML) in a patient with multiple myeloma (MM) treated with nine different MM therapies. This case report contributes to the already published 16 cases of PML in patients with MM. Additionally, this paper presents an analysis of cases from the United States Food and Drug Administration Adverse Event Report System database (n = 117) with a description of demographics and MM-specific therapies. Patients with MM, that developed PML, were treated with immunomodulatory drugs (97%), alkylating agents (52%), and/or proteasome inhibitors (49%). Prior to PML diagnosis, 72% of patients received two or more MM therapies. These results indicate that PML in MM is underreported and could be related to treatment with multiple immunosuppressive therapies rather than MM as a disease itself. Physicians should be aware of potential PML in the late stage of heavily treated MM patients.
Insights
Progressive multifocal leukoencephalopathy (PML) is a rare brain infection that can occur in multiple myeloma (MM) patients. This study suggests PML in MM may be linked to extensive immunosuppressive therapies, not just the disease itself.
Area of Science:
- Neuro-oncology
- Hematology
- Immunology
Background:
- Multiple myeloma (MM) is a hematologic malignancy.
- Progressive multifocal leukoencephalopathy (PML) is a rare, opportunistic demyelinating disease of the central nervous system.
- PML is associated with profound cellular immunodeficiency.
Observation:
- A case of PML in an MM patient treated with nine MM therapies is presented.
- Analysis of 117 cases from the FDA Adverse Event Report System database revealed PML in MM patients.
- PML patients with MM received immunomodulatory drugs (97%), alkylating agents (52%), and proteasome inhibitors (49%).
Findings:
- 72% of MM patients diagnosed with PML had received two or more MM therapies prior to diagnosis.
- PML in MM patients appears to be underreported.
- The incidence of PML in MM may be associated with cumulative exposure to multiple immunosuppressive therapies.
Implications:
- Physicians should consider PML in heavily treated MM patients, especially in later stages of the disease.
- Increased awareness of PML risk in MM patients undergoing extensive immunosuppressive treatment is warranted.
- Further research is needed to elucidate the precise relationship between MM therapies and PML development.
