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Volume 25, Number 11—November 2019
Research Letter

Effectiveness of Immune Checkpoint Inhibitors in Transplant Recipients with Progressive Multifocal Leukoencephalopathy

Chloé Medrano, François Vergez, Catherine Mengelle, Stanislas Faguer, Nassim Kamar, and Arnaud Del BelloComments to Author 
Author affiliations: Hôpital Rangueil, Toulouse, France (C. Medrano, S. Faguer, N. Kamar, A. Del Bello); Université Paul Sabatier, Toulouse (C. Medrano, F. Vergez, S. Faguer, N. Kamar, A. Del Bello); Hôpital de Toulouse, Toulouse (F. Vergez, C. Mengelle); Hôpital Purpan, Toulouse (C. Mengelle, N. Kamar, A. Del Bello)

Main Article

Table

Characteristics of 3 patients with PML who received nivolumab, France, 2017*

Patient characteristics Total lymphocytes; CD4+; CD8+, n/mm3 Clinical course Additional therapy JCV in CSF, log10 copies/mL Loss of kidney function
Patient 1: age 81 y; received transplant 5 y before PML diagnosis; received treatment with Tac, MPA, prednisone
 B: 300; 76; 56/LFU: 1,000; 602; 250†
 Rapid progression of neurologic disorders despite 2 injections of nivolumab; death from progression of PML 6 wk after diagnosis
 Mirtazapine 15 mg/d
 B: 3.5/LFU: NA
 No
Patient 2: age 77 y; received transplant 2 y before PML diagnosis; received treatment with belatacept, MPA, and prednisone
 B: 377; 162; 106/LFU: 444; 117; 210‡
 Rapid progression of neurologic disorders despite 3 injections of nivolumab; death from progression of PML 6 wk after diagnosis
 Mirtazapine 15 mg/d; γ interferon therapy (100 μg) added 1 day after second and third injections
 B: 2.9/LFU: 5
 Yes
Patient 3: age 67 y; received transplant 17 y before PML diagnosis; received treatment with Tac, MPA, prednisone B: 487; 287; 67/LFU: 2,076; 1,183; 477§ Rapid neurologic degradation despite 2 injections of nivolumab; death from progression of PML 4 wk after diagnosis Mirtazapine 15 mg/d B: 2.9/LFU: NA No

*B, baseline; CSF, cerebrospinal fluid; JCV, JC virus; LFU, last follow-up; MPA, mycophenolic acid; NA, not available, PML, progressive multifocal leukoencephalopathy; Tac, tacrolimus.
†LFU for patient 1 was 1 wk after the second injection of nivolumab.
‡LFU for patient 2 was 4 d after the third injection of nivolumab.
§LFU for patient 3 was 1 wk after the second injection of nivolumab.

Main Article

Page created: October 15, 2019
Page updated: October 15, 2019
Page reviewed: October 15, 2019
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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