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Progressive Multifocal Leukoencephalopathy: Current Insights

Authors Kartau M, Sipilä JOT, Auvinen E, Palomäki M, Verkkoniemi-Ahola A

Received 29 August 2019

Accepted for publication 14 November 2019

Published 2 December 2019 Volume 2019:9 Pages 109—121

DOI https://doi.org/10.2147/DNND.S203405

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Melinda Thomas

Peer reviewer comments 3

Editor who approved publication: Prof. Dr. Thomas Müller


Marge Kartau,1 Jussi OT Sipilä,2–4 Eeva Auvinen,5 Maarit Palomäki,6 Auli Verkkoniemi-Ahola1

1Clinical Neurosciences, Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland; 2Department of Neurology, Siun Sote, North Carelia Central Hospital, Joensuu, Finland; 3Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland; 4Clinical Neurosciences, University of Turku, Turku, Finland; 5Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; 6Neuroradiology, HUS Medical Imaging Center, Helsinki, Finland

Correspondence: Marge Kartau
Clinical Neurosciences, Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
Email marge.kartau@hus.fi

Abstract: Cases of PML should be evaluated according to predisposing factors, as these subgroups differ by incidence rate, clinical course, and prognosis. The three most significant groups at risk of PML are patients with hematological malignancies mostly previously treated with immunotherapies but also untreated, patients with HIV infection, and patients using monoclonal antibody (mAb) treatments. Epidemiological data is scarce and partly conflicting, but the distribution of the subgroups appears to have changed. While there is no specific anti-JCPyV treatment, restoration of the immune function is the most effective approach to PML treatment. Research is warranted to determine whether immune checkpoint inhibitors could benefit certain PML subgroups. There are no systematic national or international records of PML diagnoses or a risk stratification algorithm, except for MS patients receiving natalizumab (NTZ). These are needed to improve PML risk assessment and to tailor better prevention strategies.

Keywords: progressive multifocal leukoencephalopathy, JC polyomavirus, monoclonal antibodies, HIV, multiple sclerosis, disease modifying therapies
 

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