ArticleAnnals of clinical and translational neurology2019
Treatment of natalizumab-associated PML with filgrastim.
Article in Annals of clinical and translational neurology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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17 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
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- Brain Immune Cell Composition in Multiple Sclerosis and Progressive Multifocal Leukoencephalopathy After Natalizumab: An Immunohistochemical Cohort Study.Neurology(R) neuroimmunology & neuroinflammation · 2026Article
- JC Polyomavirus Infection: A Narrative Review.Infectious diseases and therapy · 2025Review
- Natalizumab-associated progressive multifocal leukoencephalopathy.Frontiers in neurology · 2025Review
- Biomarkers for progressive multifocal leukoencephalopathy: emerging data for use of JC virus DNA copy number in clinical trials.The Lancet. Neurology · 2024Review
- Fingolimod-associated progressive multifocal leukoencephalopathy in a multiple sclerosis patient with a good response to filgrastim.Journal of neurology · 2023Article
- Case report: Use of granulocyte-colony stimulating factor as an immunomodulatory therapy in a patient with neuromyelitis optica spectrum disorder and comorbid immunodeficiency.Frontiers in neurology · 2023Article
- Progressive multifocal leukoencephalopathy associated with chemotherapy induced lymphocytopenia in solid tumors - case report of an underestimated complication.Frontiers in oncology · 2022Article
- Advances in Treatment of Progressive Multifocal Leukoencephalopathy.Annals of neurology · 2021Review
- BK virus-specific T cells for immunotherapy of progressive multifocal leukoencephalopathy: an open-label, single-cohort pilot study.The Lancet. Neurology · 2021Article
- Central Nervous System Infections in Immunocompromised Patients.Current neurology and neuroscience reports · 2021Review
- Improving risk-stratification of natalizumab-associated PML.Annals of clinical and translational neurology · 2021Article
- Progressive multifocal leukoencephalopathy and the spectrum of JC virus-related disease.Nature reviews. Neurology · 2021Review
- A Case of Progressive Multifocal Leukoencephalopathy in a Fumaric Acid-Treated Psoriasis Patient With Severe Lymphopenia Among Other Risk Factors.Journal of central nervous system disease · 2021Article
- JC Polyomavirus, progressive multifocal leukoencephalopathy and immune reconstitution inflammatory syndrome: a review.AIDS research and therapy · 2020Review
- Treatment of Progressive Multifocal Leukoencephalopathy Using Immune Restoration.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2020Review
- Progressive Multifocal Leukoencephalopathy: Current Insights.Degenerative neurological and neuromuscular disease · 2019Review
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6 authors at 3 institutions in 1 country.
Funding
Abstract
objectiveThere is no consensus on the treatment of progressive multifocal leukoencephalopathy (PML) occurring in multiple sclerosis (MS) patients treated with natalizumab (Nz). We report novel immune activating treatment with filgrastim of Nz-associated PML in MS patients treated at Rush University Medical Center.
methodsWe retrospectively analyzed 17 Nz-PML patients treated at this single tertiary referral center between 2010 and 2017. We reviewed the clinical symptoms, diagnostic methods, survival, outcome and MS modifying therapy (MSMT) after Nz-PML.
resultsPML occurred after an average of 49 Nz infusions. To facilitate JCV elimination by accelerating immune reconstitution inflammatory syndrome (IRIS), all patients received subcutaneous filgrastim upon PML diagnosis and discontinuation of Nz; eight received plasma exchange (PLEX). Earlier than previously published, PML-IRIS occurred in 15 of 17 (88.2%) patients within a mean of 57.4 days (SD 21.20) after the last Nz infusion. Seven patients recovered to or near baseline. There were no PML/IRIS-related fatalities but one patient committed suicide 2.5 years later. PLEX had no impact on PML outcome. Of 17 patients, 3 (18%) had MS relapses within 1 year after PML, and 5 (29%) beyond 1 year of PML onset, which is lower than expected in highly active MS patients. Eight patients started MSMTs after Nz-PML on an average of 26 months after Nz withdrawal.
interpretationOur findings indicate that immunoactivation with filgrastim during PML and careful management of subsequent IRIS is likely beneficial in patients with Nz-PML, without worsening MS. The clinical course of MS may be ameliorated by PML.
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