Ibrutinib Use Complicated by Progressive Multifocal Leukoencephalopathy

被引：10

作者：

Hsiehchen, David ^{[1
]}

Arasaratnam, Reuben ^{[2
]}

Raj, Karuna ^{[3
]}

Froehlich, Thomas ^{[1
]}

Anderson, Larry ^{[1
]}

机构：

[1] Univ Texas Southwestern Med Ctr Dallas, Div Hematol & Oncol, Dept Internal Med, 5323 Harry Hines Blvd, Dallas, TX 75390 USA

[2] Univ Texas Southwestern Med Ctr Dallas, Dept Internal Med, Div Infect Dis, Dallas, TX 75390 USA

[3] Univ Texas Southwestern Med Ctr Dallas, Dept Radiol, Dallas, TX 75390 USA

来源：

ONCOLOGY | 2018年 / 95卷 / 05期

关键词：

Ibrutinib; Progressive multifocal leukoencephalopathy; Chronic lymphocytic leukemia; CHRONIC LYMPHOCYTIC-LEUKEMIA; CELL TRANSPLANTATION; TYROSINE KINASE; THERAPY; INTERLEUKIN-2; INHIBITOR; LYMPHOMA;

D O I：

10.1159/000490617

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disease associated with immunocompromised states. We describe a case of PML, which developed after prolonged ibrutinib use and a low burden of chronic lymphocytic leukemia disease. The delay in diagnosis of the patient despite multiple presentations to medical providers across different facilities suggests that there is a lack of awareness of PML as a potential complication of ibrutinib. Treatments with postulated anti-John Cunningham polyomavirus agents and IL-2 were ineffective, likely due to the advanced state of the patient's disease. Although recent evidence indicates that ibrutinib may enhance cell-mediated immunity, consistent with elevated CD4+ and CD8+ T cells and appropriate T-cell response to mitogens in the patient, ibrutinib-mediated inhibition of the humoral function may contribute to PML pathogenesis. As the duration of ibrutinib use is often indefinite, and the number of indications for ibrutinib continues to grow, recognition and further evaluation of the link between PML and ibrutinib is warranted.

引用

页码：319 / 322

页数：4

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