PMID- 22123933
OWN - NLM
STAT- MEDLINE
DCOM- 20120418
LR  - 20151119
IS  - 1939-2869 (Electronic)
IS  - 0891-1150 (Linking)
VI  - 78 Suppl 2
DP  - 2011 Nov
TI  - Advances in the management of PML: focus on natalizumab.
PG  - S33-7
LID - 10.3949/ccjm.78.s2.08 [doi]
AB  - Progressive multifocal leukoencephalopathy (PML), a rare opportunistic infection 
      of the central nervous system, occurs mainly in the setting of broad-based and 
      selective immunosuppression. The immunomodulatory agent most often implicated in 
      the development of PML is the monoclonal antibody natalizumab. Management of PML 
      begins with risk stratification. Factors that predict the risk of PML are JC 
      virus (JCV) antibody status, history of chemotherapy use, and cumulative exposure 
      to natalizumab. The risk of natalizumab-related PML increases up to a duration of 
      36 months of therapy, after which the risk appears to level off. If suspicious 
      for PML, the use of a sensitive JCV polymerase chain reaction assay permits early 
      diagnosis. Immune reconstitution represents the mainstay of treatment for PML. 
      With rapid reversal of immunosuppression followed by immunologic recovery, almost 
      all patients suffer clinical deterioration termed immune reconstitution 
      inflammatory syndrome (IRIS). High-dose corticosteroids are often recommended if 
      a clinical and imaging syndrome resembling IRIS develops after immune 
      restoration.
FAU - Fox, Robert
AU  - Fox R
AD  - Mellen Center for Multiple Sclerosis, Cleveland Clinic, 9500 Euclid Ave., U10, 
      Cleveland, OH 44195, USA. foxr@ccf.org
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Cleve Clin J Med
JT  - Cleveland Clinic journal of medicine
JID - 8703441
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - 0 (Antibodies, Viral)
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Natalizumab)
SB  - IM
EIN - Cleve Clin J Med. 2012 May;79(5):312
MH  - Antibodies, Monoclonal, Humanized/*adverse effects
MH  - Antibodies, Viral/*blood
MH  - Humans
MH  - Immunosuppressive Agents/adverse effects
MH  - JC Virus/immunology
MH  - Leukoencephalopathy, Progressive Multifocal/drug therapy/immunology/*virology
MH  - Natalizumab
MH  - Time Factors
EDAT- 2011/12/14 06:00
MHDA- 2012/04/19 06:00
CRDT- 2011/11/30 06:00
PHST- 2011/11/30 06:00 [entrez]
PHST- 2011/12/14 06:00 [pubmed]
PHST- 2012/04/19 06:00 [medline]
AID - 78/Suppl_2/S33 [pii]
AID - 10.3949/ccjm.78.s2.08 [doi]
PST - ppublish
SO  - Cleve Clin J Med. 2011 Nov;78 Suppl 2:S33-7. doi: 10.3949/ccjm.78.s2.08.