Pembrolizumab for the treatment of progressive multifocal leukoencephalopathy following anti‐CD19 CAR‐T therapy: a case report
Strachan Mackenzie,
Manar Shafat,
Harriet Roddy,
Harpreet Hyare,
Lorna Neill,
Maria A. V. Marzolini,
Michael Gilhooley,
Teresa Marafioti,
Eleanna Kara,
Emilie Sanchez,
Jeremy Rees,
David S. Lynch,
Kirsty Thomson,
Kirit M. Ardeshna,
Arian Laurence,
Karl S. Peggs,
Maeve O'Reilly,
Claire Roddie
Affiliations
Strachan Mackenzie
UCL Cancer Institute Paul O'Gorman Building University College London London UK
Manar Shafat
UCL Cancer Institute Paul O'Gorman Building University College London London UK
Harriet Roddy
UCL Cancer Institute Paul O'Gorman Building University College London London UK
Harpreet Hyare
Department of Haematology University College London Hospital NHS Foundation Trust London UK
Lorna Neill
Department of Haematology University College London Hospital NHS Foundation Trust London UK
Maria A. V. Marzolini
Department of Haematology University College London Hospital NHS Foundation Trust London UK
Michael Gilhooley
The Institute of Ophthalmology University College London Bath Street London UK
Teresa Marafioti
Department of Histopathology University College London 60 Whitfield Street London UK
Eleanna Kara
Department of Neuropathology National Hospital of Neurology and Neurosurgery University College London Hospital NHS Foundation Trust Queen Square London UK
Emilie Sanchez
Department of Virology University College London Hospital NHS Foundation Trust London UK
Jeremy Rees
Institute of Neurology National Hospital of Neurology and Neurosurgery University College London Queen Square London UK
David S. Lynch
Institute of Neurology National Hospital of Neurology and Neurosurgery University College London Queen Square London UK
Kirsty Thomson
Department of Haematology University College London Hospital NHS Foundation Trust London UK
Kirit M. Ardeshna
Department of Haematology University College London Hospital NHS Foundation Trust London UK
Arian Laurence
Department of Haematology University College London Hospital NHS Foundation Trust London UK
Karl S. Peggs
UCL Cancer Institute Paul O'Gorman Building University College London London UK
Maeve O'Reilly
Department of Haematology University College London Hospital NHS Foundation Trust London UK
Claire Roddie
UCL Cancer Institute Paul O'Gorman Building University College London London UK
Abstract 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.
