Characteristics and outcomes of progressive multifocal leukoencephalopathy in hematologic malignancies and stem cell transplant – a case series

Diego Adrianzen Herrera, Sabarish Ayyappan, Sakshi Jasra, Noah Kornblum, Olga Derman, Aditi Shastri, Ioannis Mantzaris, Amit K. Verma, Ira Braunschweig, Murali Janakiram

Research output: Contribution to journalArticle

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Abstract

Progressive multifocal leukoencephalopathy (PML) is a life-threatening opportunistic infection of immunomodulatory therapies. PML cases reported in PubMed (1995–2017) following stem-cell transplantation (HSCT) or chemoimmunotherapy (CIT) for hematologic malignancies were reviewed. We found 107 cases, 40% were HSCT recipients (32 allogeneic, 11 autologous) and 40% indolent lymphomas receiving monoclonal antibodies (mAbs). HSCT cases had longer time to PML diagnosis (10.8 vs. 4 months, p < .001), higher proportion of PML therapy response (58% vs. 25%, p = .019), lower mortality rate (56% vs. 88%, p < .001), and longer median survival (8 vs. 2 months, p < .001). Outcome differences might be caused by selection bias as HSCT patients are most likely treated aggressively; however, time-dependent immune reconstitution might also contribute to their better prognosis. Increased use of mAbs and HSCT are associated with rising PML incidence in hematological malignancies, currently constituting the second largest vulnerable population after HIV-infected patients; further research is needed for its optimal treatment.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalLeukemia and Lymphoma
DOIs
StateAccepted/In press - Jun 28 2018

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Progressive Multifocal Leukoencephalopathy
Hematologic Neoplasms
Stem Cells
Transplants
Monoclonal Antibodies
Immunomodulation
Selection Bias
Opportunistic Infections
Stem Cell Transplantation
Vulnerable Populations
PubMed
Lymphoma
HIV
Survival
Mortality
Incidence
Therapeutics
Research

Keywords

  • hematologic malignancies
  • monoclonal antibodies
  • Progressive multifocal leukoencephalopathy
  • stem cell transplantation

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

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title = "Characteristics and outcomes of progressive multifocal leukoencephalopathy in hematologic malignancies and stem cell transplant – a case series",
abstract = "Progressive multifocal leukoencephalopathy (PML) is a life-threatening opportunistic infection of immunomodulatory therapies. PML cases reported in PubMed (1995–2017) following stem-cell transplantation (HSCT) or chemoimmunotherapy (CIT) for hematologic malignancies were reviewed. We found 107 cases, 40{\%} were HSCT recipients (32 allogeneic, 11 autologous) and 40{\%} indolent lymphomas receiving monoclonal antibodies (mAbs). HSCT cases had longer time to PML diagnosis (10.8 vs. 4 months, p < .001), higher proportion of PML therapy response (58{\%} vs. 25{\%}, p = .019), lower mortality rate (56{\%} vs. 88{\%}, p < .001), and longer median survival (8 vs. 2 months, p < .001). Outcome differences might be caused by selection bias as HSCT patients are most likely treated aggressively; however, time-dependent immune reconstitution might also contribute to their better prognosis. Increased use of mAbs and HSCT are associated with rising PML incidence in hematological malignancies, currently constituting the second largest vulnerable population after HIV-infected patients; further research is needed for its optimal treatment.",
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AU - Ayyappan, Sabarish

AU - Jasra, Sakshi

AU - Kornblum, Noah

AU - Derman, Olga

AU - Shastri, Aditi

AU - Mantzaris, Ioannis

AU - Verma, Amit K.

AU - Braunschweig, Ira

AU - Janakiram, Murali

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