A Case of Progressive Multifocal Leukoencephalopathy Caused by Epcoritamab
Chifumi Iseki1,2, Kazuo Nakamichi3, Kenichi Ishizawa4
1Division of Neurology and Clinical Neuroscience, Department of Internal Medicine Ⅲ, Yamagata University, Yamagata, JPN.
Cureus
|November 18, 2024
Summary
This case report details a patient with follicular lymphoma who developed progressive multifocal leukoencephalopathy (PML) after treatment with epcoritamab. This highlights a potential risk of PML with novel T-cell redirecting therapies.
Area of Science:
- Oncology
- Neurology
- Immunology
Background:
- Follicular lymphoma (FL) is a common non-Hodgkin lymphoma.
- Epcoritamab is a bispecific antibody targeting CD3 and CD20, used for treating B-cell malignancies.
- Progressive multifocal leukoencephalopathy (PML) is a rare, fatal demyelinating disease caused by JC virus reactivation in immunocompromised individuals.
Observation:
- A patient with recurrent FL achieved complete molecular remission with epcoritamab.
- The patient subsequently developed PML, characterized by neurological deficits and specific MRI findings.
- Elevated JC virus DNA levels in cerebrospinal fluid confirmed PML diagnosis.
Findings:
- This is the first reported case of PML as a complication of epcoritamab therapy.
- The patient experienced fatal neurological decline following PML diagnosis.
- Laboratory findings indicated significant immunodeficiency, including low CD4+ and CD8+ T-cell counts.
Implications:
- Awareness of PML risk is crucial with novel immunotherapies like epcoritamab.
- Further research is needed to understand the mechanisms and risk factors for PML in patients receiving T-cell redirecting agents.
- Consideration of JCV antibody testing may be warranted in patients with specific risk factors or symptoms suggestive of PML during novel cancer therapy.
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