2011
DOI: 10.1111/j.1469-0691.2011.03653.x
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Progressive multifocal leukoencephalopathy: an unexpected complication of modern therapeutic monoclonal antibody therapies

Abstract: Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disorder of the central nervous system, caused by the reactivation of the ubiquitous JC virus. PML usually occurs during severe immunosuppression, and the most common causes are represented by human immunodeficiency virus infection, lymphoproliferative disorders and other forms of cancer. Recently, the introduction of monoclonal antibodies (e.g. natalizumab, rituximab, efalizumab) in the treatment of several dysimmune diseases such as mul… Show more

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Cited by 61 publications
(54 citation statements)
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“…They reduce active neuroinflammation, but their lack of selectivity comes with an increase in the risk of developing opportunistic infections [60,61]. Although infectious complications occur during the neutropenic phase of HSCT, the risk of late opportunistic infections is small once immune reconstitution has occurred.…”
Section: Lesson 8: Tolerance Can Develop Resulting In Obliteration Ofmentioning
confidence: 99%
“…They reduce active neuroinflammation, but their lack of selectivity comes with an increase in the risk of developing opportunistic infections [60,61]. Although infectious complications occur during the neutropenic phase of HSCT, the risk of late opportunistic infections is small once immune reconstitution has occurred.…”
Section: Lesson 8: Tolerance Can Develop Resulting In Obliteration Ofmentioning
confidence: 99%
“…Therefore, PML following rituximab therapy develops in conjunction with the reconstitution of the B-cell population 5 , as in our patient who presented clinical symptoms two months after completion of rituximab treatment. The mechanism underlying viral reactivation after rituximab treatment is probably more complex than simple B-cell depletion 2,13 . Additionally, rituximab may also have reduced CD3 T-cells in the CSF 5 .…”
Section: Discussionmentioning
confidence: 99%
“…PML is multisymptomatic presenting with a wide clinical spectrum 8 . Neurological symptoms and signs may be focal or diffuse and may include motor deficits, visual symptoms, altered consciousness gait and ataxia 2 . Some studies have developed and validated less invasive diagnostic methods based on the detection of the virus in CSF by PCR 1 .…”
Section: Discussionmentioning
confidence: 99%
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“…DarĂŒber hinaus kann eine Anti-CD20-Therapie zu einer Reaktivierung von Hepatitis B fĂŒhren, die nicht selten fulminant verlĂ€uft [59]. Weiters kann eine Anti-CD20-Therapie -wie auch andere immunsuppressive Therapien mit monoklonalen Antikörpern -sporadisch zum Auftreten einer progressiven multifokalen Leukenzephalopathie (PML) durch Reaktivierung des JCVirus fĂŒhren [60].…”
Section: Diabetes Mellitusunclassified