The MS community has unwillingly become far too familiar with PML over the past few months thanks to the issues surrounding Tysabri. One of the primary questions that circulates is with respect to whether someone who develops PML due to artificial immunomodulation/suppression rather than an inherent defect with their immune system (e.g., a Tysabri patient versus an HIV patient) can recover on removal of the purportedly suppressing agent (e.g., Tysabri, Imuran, etc.).
Here is a case presented last week where a kidney transplant patient developed PML due to administration of heavy anti-rejection (immunosuppressive) drugs, then completely recovers on detection and stoppage of dosing. Note that significant damage is detected at the time of PML diagnosis... then it clears entirely!
While certainly contracting then reversing PML presents a frightening picture overall despite the outcome, this case study is hopeful for our community-- not only with respect to Tysabri but to any of the future novel immunomodulating drugs that MS patients are bound to face. If nothing else, it is abundantly clear that altering something as intricate and complex as the human immune system, even in an attempt for overwhelming benefit, risks many unknown and potentially lethal hazards. Certainly it is ideal to thoroughly classify and eliminatre this risk, but there comes a point where if after 8 years of clinical trials (e.g., Tysabri) you still cannot quantify the risk but can quantify the benefits, we must become comfortable facing some element of the unknown-- and one major aspect of doing that is to be prepared to handle possible negative outcomes if and when they arise.
"We report the case of a 47-year-old man who developed progressive multifocal leukoencephalopathy (PML) after receiving immuno-suppressive therapy for renal transplantation...
Immunosuppression was discontinued and the neurological symptoms gradually resolved over a period of 4 weeks. The patient is free of any neurological symptoms 36 months after the diagnosis of PML and imaging studies demonstrate resolution of the PML lesions."
Click "read more" for the full abstract...
Full AbstractSuccessful outcome of progressive multifocal leukoencephalopathy in a renal transplant patient.
Crowder CD, Gyure KA, Drachenberg CB, Werner J, Morales RE, Hirsch HH, Ramos E.
Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
We report the case of a 47-year-old man who developed progressive multifocal leukoencephalopathy (PML) after receiving immuno-suppressive therapy for renal transplantation. The patient presented with a focal seizure and cognitive changes 5 months post-transplantation. He was found to have enhancing lesions in the parietal lobe and typical findings of PML in a brain biopsy. Immunosuppression was discontinued and the neurological symptoms gradually resolved over a period of 4 weeks. The patient is free of any neurological symptoms 36 months after the diagnosis of PML and imaging studies demonstrate resolution of the PML lesions. The patient returned to hemodialysis 3 months after immunosuppression was discontinued. We also present a review of the literature on PML in renal transplant recipients.
PMID: 15816900 [PubMed - in process]
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