Open AccessPembrolizumab for the treatment of progressive multifocal leukoencephalopathy following anti‐CD19 CAR‐T therapy: a case report
Author(s) -
Mackenzie Strachan,
Shafat Manar,
Roddy Harriet,
Hyare Harpreet,
Neill Lorna,
Marzolini Maria A. V.,
Gilhooley Michael,
Marafioti Teresa,
Kara Eleanna,
Sanchez Emilie,
Rees Jeremy,
Lynch David S.,
Thomson Kirsty,
Ardeshna Kirit M.,
Laurence Arian,
Peggs Karl S.,
O'Reilly Maeve,
Roddie Claire
Publication year - 2021
Publication title -
ejhaem
Language(s) - English
Resource type - Journals
ISSN - 2688-6146
DOI - 10.1002/jha2.274
Subject(s) - progressive multifocal leukoencephalopathy , pembrolizumab , blockade , medicine , chimeric antigen receptor , leukoencephalopathy , immune system , jc virus , immunology , immune checkpoint , immunotherapy , receptor , virus , disease
Progressive multifocal leukoencephalopathy (PML) is an opportunistic brain infection with few treatment options and poor survival when reversal of the underlying immune dysfunction is not achievable. JC polyomavirus reactivation resulting in PML can rarely complicate chimeric antigen receptor T‐cell (CAR‐T) therapy. We describe successful treatment of PML with Programmed death‐1 (PD‐1) blockade using pembrolizumab, 4 months following axicabtagene ciloleucel. Radiological features of immune reconstitution inflammatory syndrome without clinical deterioration were seen. Evidence of anti‐viral immune reconstitution by in vitro detection of JC‐specific T‐cells and sustained neurological recovery in this patient suggest PD‐1 blockade may be an effective treatment approach for PML post‐CAR‐T.