Progressive multifocal leukoencephalopathy after durvalumab treatment for acute myeloid leukemia: A consequence of an immune reconstitution inflammatory syndrome?

eJHaem

article

Emeline Vinatier¹  Caroline Poli¹  Aurélien Giltat³  Christopher Nunes-Gomes³  Corentin Orvain²  Mathilde Hunault-Berger²  Pascale Jeannin¹  Sylvain Thépot² 

[1] CHU Angers, Laboratoire d'Immunologie et Allergologie;Univ Angers, Nantes Université;CHU Angers

关键词: acute leukemia;    immunopathology;    immunotherapy;    infection;   

DOI  :  10.1002/jha2.485

来源: Wiley

【 摘 要 】

Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disease of the central nervous system resulting from the reactivation of the John Cunningham virus (JCV). PML occurs almost exclusively during profound immune suppression but it can also be observed in immunocompromised subjects as part of an inflammatory immune reconstitution syndrome (IRIS) in patients receiving antiviral therapy. We report a case of PML in a 61-year-old patient with acute myeloid leukemia who had developed after discontinuation of durvalumab (anti-PD-L1) therapy initiated after multiple treatments. Results suggest that PML may result from two nonexclusive mechanisms: (i) an inhibition of the protective response of JCV-specific T cells as a consequence of the blockade of the PD1-PDL1 pathway, associated with a lack of compensatory expression of other inhibitory receptors by T cells and (ii) a neuroinflammatory response (PML-IRIS) that may have contributed to virus reactivation.

【 授权许可】

Unknown