PMID- 24200614
OWN - NLM
STAT- MEDLINE
DCOM- 20140306
LR  - 20131108
IS  - 1881-6096 (Print)
IS  - 1881-6096 (Linking)
VI  - 65
IP  - 11
DP  - 2013 Nov
TI  - [Targeted therapy and progressive multifocal leukoencephalopathy (PML): PML in 
      the era of monoclonal antibody therapies].
PG  - 1363-74
AB  - Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of 
      the central nervous system and is associated with John Cunningham (JC) virus 
      infection in the oligodendrocytes. The number of patients with PML increased 
      after the pandemic of acquired immunodeficiency syndrome. Thereafter, an 
      association between PML and monoclonal antibody therapy has come into light. Thus 
      far, several monoclonal antibodies have been reported to cause PML. Currently, 
      according to the Barts and the London School of Medicine and Dentistry, the 
      number of PML cases due to natalizumab treatment for multiple sclerosis is 395 
      (incidence is 3.28/1,000). Moreover, the number of individuals with PML due to 
      rituximab treatment is increasing (over 100 cases). Efalizumab, infliximab, 
      adalimumab, etanercept, ibritumomab tiuxetan, bevacizumab, alemtuzumab, 
      cetuximab, and brentuximab are also reported as risk factors of PML. The 
      diagnosis of PML is based on clinical, neuroradiological, pathological, and 
      molecular analyses. In clinical setting, magnetic resonance imaging provides the 
      most important information in the diagnosis of PML. Patients with PML due to 
      monoclonal antibody treatment may present clinical symptoms different from that 
      of the classic PML, such as sensory disturbance and seizure. Once PML is 
      identified in an individual receiving monoclonal antibody therapy, the monoclonal 
      antibody must be immediately discontinued and removed from the body by 
      plasmapheresis. Because most patients may present immune reconstitution 
      inflammatory syndrome (IRIS), steroid therapy must be considered immediately. 
      However, the prognosis of PML is still worse in patients receiving monoclonal 
      antibody therapy. To prevent PML development, sophisticated and well-organized 
      strategies must be established for monoclonal antibody treatment. Besides 
      neurologists, physicians from other fields must be aware of PML associated with 
      resulted from monoclonal antibody therapy.
FAU - Takao, Masaki
AU  - Takao M
AD  - Department of Neuropathology, the Brain Bank for Aging Research, Tokyo 
      Metropolitan Geriatric Hospital and Institute of Gerontology.
LA  - jpn
PT  - English Abstract
PT  - Journal Article
PT  - Review
PL  - Japan
TA  - Brain Nerve
JT  - Brain and nerve = Shinkei kenkyu no shinpo
JID - 101299709
RN  - 0 (Antibodies, Monoclonal)
SB  - IM
MH  - Antibodies, Monoclonal/*therapeutic use
MH  - Humans
MH  - JC Virus/immunology
MH  - Leukoencephalopathy, Progressive Multifocal/diagnosis/*drug therapy/immunology
MH  - *Molecular Targeted Therapy
MH  - Multiple Sclerosis/diagnosis/drug therapy
MH  - Practice Guidelines as Topic
EDAT- 2013/11/10 06:00
MHDA- 2014/03/07 06:00
CRDT- 2013/11/09 06:00
PHST- 2013/11/09 06:00 [entrez]
PHST- 2013/11/10 06:00 [pubmed]
PHST- 2014/03/07 06:00 [medline]
AID - 1416101647 [pii]
PST - ppublish
SO  - Brain Nerve. 2013 Nov;65(11):1363-74.