Immune profiling of a patient with alemtuzumab-associated progressive multifocal leukoencephalopathy. (July 2019)

• Record Type: Journal Article
• Authors: Gerevini, Simonetta; Capra, Ruggero; Bertoli, Diego; Sottini, Alessandra; Imberti, Luisa
• Is Part Of: Multiple sclerosis. Volume 25:Number 8(2019)
• Page Start: 1196
• Page End: 1201
• Publication Date: 2019-07
• Subjects: PML -- alemtuzumab -- TRECs -- KRECs -- T-cell receptor repertoire -- B-cell receptor repertoire; Central nervous system -- Diseases -- Periodicals; Myelin sheath -- Diseases -- Periodicals; Inflammation -- Periodicals; Multiple sclerosis -- Periodicals; Central Nervous System Diseases -- Periodicals; Demyelinating Diseases -- Periodicals; Inflammation -- Periodicals; Multiple Sclerosis -- Periodicals; Système nerveux central -- Maladies -- Périodiques; Gaine de myéline -- Maladies -- Périodiques; Inflammation (Pathologie) -- Périodiques; Sclérose en plaques -- Périodiques; Electronic journals; 616.834005
• DOI: 10.1177/1352458519832259
• Languages: English
• ISSNs: 1352-4585

Abstract

A 31-year-old woman affected by multiple sclerosis (MS) experienced generalized tonic–clonic seizures 2 months after the second alemtuzumab cycle. Positive JC virus (JCV)-DNA in cerebrospinal fluid (CSF) and lesion iconography at magnetic resonance imaging (MRI) were suggestive of progressive multifocal leukoencephalopathy (PML). After 1 month, during full-blown immune reconstitution inflammatory syndrome, JCV-DNA became negative and symptoms gradually improved. New T- and B-cell output and T- and B-cell diversity were low and lymphocytes poorly responded to stimulation. This is the first case of an alemtuzumab-treated patient with clinical symptoms and radiological features compatible with PML. The lack of large T- and B-cell diversity, necessary for JCV recognition, is likely to have concurred to PML insurgence.