Progressive multifocal leukoencephalopathy in multiple myeloma

Abstract

Progressive multifocal leukoencephalopathy (PML) is a rare and often fatal demyelinating disease of the central nervous system caused by reactivation of the JC virus in the context of immune suppression such as HIV, malignancy, and certain immunomodulatory medications. PML has been reported only rarely in multiple myeloma patients, and its presenting features and natural history in this population are not well known. We describe six cases of PML among multiple myeloma patients treated at our institution between 2013 and 2022, including two that developed on or shortly after treatment with recently developed BCMA‐directed immunotherapies.

Progressive Multifocal Leukoencephalopathy Unmasked by Teclistamab in a Refractory Multiple Myeloma Patient

“…Recently, the rise in targeted therapies and immunotherapies for cancer has led to an increase in PML cases associated with these treatments, as evidenced by a significant growth in case reports over the past few years [17]. Specifically, six instances of PML in MM patients have been documented between 2013 and 2022, with one case emerging post-CAR T-cell therapy, and another following teclistamab treatment during a clinical trial [18]. These patients often presented with motor weakness, cognitive dysfunction, and sensory deficits shortly after beginning these treatments, indicating an elevated risk of PML.…”

“…Diagnosis was primarily confirmed through MRI imaging. Despite treatment efforts, the prognosis for PML in these patients tends to be poor, with rapid disease progression and high mortality rates [18].…”