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Progressive multifocal leukoencephalopathy (PML) is a viral infection predominantly seen
in patients with HIV infection. However, with the increased use of monoclonal antibodies
(MAB) for various lymphoproliferative disorders, we are now seeing this infection in
non-HIV patients on drugs such as natalizumab, rituximab, and so on. The aim of this
article is to review the relationship between the occurrence of PML and MAB used in the
treatment of hematological malignancies and autoimmune diseases. Review of articles from
PubMed-indexed journals which study PML in relation to the use of MAB. Relevant literature
demonstrated an increased risk of reactivation of latent John Cunningham polyomavirus
(JCV) resulting in development of PML in patients on long-term therapy with MAB. The
highest incidence of 1 PML case per 1000 treated patients and 1 case per 32 000 was
observed in patients treated with natalizumab and rituximab, respectively. Serological and
polymerase chain reaction tests for the detection of JCV can be helpful in risk
stratification of patients for the development of PML before and during therapy with MAB.
Treatment with MAB can result in development of PML. Clinicians should include PML in
differential diagnosis in patients treated with these agents if they manifest central
nervous system symptoms.
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