No evidence of beneficial effects of plasmapheresis in natalizumab-associated PML

Abstract

This study provides Class III evidence that for patients with NTZ-PML, PLEX does not improve survival. The study lacks the statistical precision to exclude an important benefit or harm of PLEX.

Natalizumab granule cell neuronopathy: FDG-PET in diagnosis and immune reconstitution with G-CSF

“…In addition, plasma exchange has been shown to be ineffective in natalizumab-associated PML cases. 8 Faced with progressive clinical deterioration and rising JCV-DNA in the CSF despite steroids, it was decided to start G-CSF, a glycoprotein, which primarily stimulates the production, mobilization, and survival of neutrophils, to initiate immune reconstitution in December 2016. Stefoski highlighted the clinical benefit of G-CSF in PML in 8/16 patients, with the desired response of immune-boosting leukocytosis and lymphocytosis resulting in IRIS in 16/18 patients.…”

Natalizumab Associated Progressive Multifocal Leukoencephalopathy-Immune Reconstitution Inflammatory Syndrome in a Patient with Multiple Sclerosis: Case Report

“…According to these findings, they suggested that the spontaneous recovery of immunocompetence after natalizumab withdrawal might counteract the spread of PML and therefore not require any additional intervention. 9 In a case report, plasmapheresis was not performed due to lesion being asymptomatic and of a small size. The consequent IRIS was quite limited in time and space.…”

The use of natalizumab for multiple sclerosis

“…There are small case series showing the efficacy of maroviroc (a CCR5 antagonist) for the treatment of PML-IRIS 58,59. A more detailed discussion regarding the approach to treatment of natalizumab-associated PML is beyond the scope of this review but is available elsewhere 54,57,60,61…”