Sequential treatment of progressive multifocal leukoencephalopathy with intravenous immunoglobulins and pembrolizumab

Area of Science:

• Neuroimmunology
• Viral Diseases of the Central Nervous System

Background:

• Progressive multifocal leukoencephalopathy (PML) is a rare, severe demyelinating disease of the central nervous system (CNS).
• PML is caused by the human polyomavirus 2 (JCV) and primarily affects immunocompromised individuals.
• Currently, no specific antiviral therapy exists for PML; immune system restoration is the main treatment strategy.

Observation:

• A case series in 2019 suggested pembrolizumab, a PD-1 inhibitor, as a potential PML treatment.
• Subsequent case reports have not consistently confirmed positive outcomes with pembrolizumab monotherapy.
• Pembrolizumab targets the PD-1 receptor on lymphocytes, potentially enhancing virus-specific T cell responses.

Findings:

• This report details a patient diagnosed with PML.
• The patient received a combination treatment regimen.
• The regimen included intravenous immunoglobulins (IVIg), maraviroc, and pembrolizumab.

Implications:

• This combined treatment approach demonstrated a beneficial outcome in a PML patient.
• Further investigation into combination therapies for PML is warranted.
• This case highlights a potential therapeutic avenue for managing PML in immunocompromised patients.