Ibrutinib use complicated by progressive multifocal leukoencephalopathy

David Hsiehchen, Reuben Jonathan Arasaratnam, Karuna Raj, Thomas W Froehlich, Larry Anderson

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disease associated with immunocompromised states. We describe a case of PML, which developed after prolonged ibrutinib use and a low burden of chronic lymphocytic leukemia disease. The delay in diagnosis of the patient despite multiple presentations to medical providers across different facilities suggests that there is a lack of awareness of PML as a potential complication of ibrutinib. Treatments with postulated anti-John Cunningham polyomavirus agents and IL-2 were ineffective, likely due to the advanced state of the patient's disease. Although recent evidence indicates that ibrutinib may enhance cell-mediated immunity, consistent with elevated CD4+ and CD8+ T cells and appropriate T-cell response to mitogens in the patient, ibrutinib-mediated inhibition of the humoral function may contribute to PML pathogenesis. As the duration of ibrutinib use is often indefinite, and the number of indications for ibrutinib continues to grow, recognition and further evaluation of the link between PML and ibrutinib is warranted.

Original languageEnglish (US)
Pages (from-to)319-322
Number of pages4
JournalOncology (Switzerland)
Volume95
Issue number5
DOIs
StatePublished - Oct 1 2018

Fingerprint

Progressive Multifocal Leukoencephalopathy
T-Lymphocytes
Polyomavirus
Demyelinating Diseases
B-Cell Chronic Lymphocytic Leukemia
PCI 32765
Mitogens
Cellular Immunity
Interleukin-2

Keywords

  • Chronic lymphocytic leukemia
  • Ibrutinib
  • Progressive multifocal leukoencephalopathy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Ibrutinib use complicated by progressive multifocal leukoencephalopathy. / Hsiehchen, David; Arasaratnam, Reuben Jonathan; Raj, Karuna; Froehlich, Thomas W; Anderson, Larry.

In: Oncology (Switzerland), Vol. 95, No. 5, 01.10.2018, p. 319-322.

Research output: Contribution to journalArticle

@article{4ea38bf1c2a1424caaa44256552a2668,
title = "Ibrutinib use complicated by progressive multifocal leukoencephalopathy",
abstract = "Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disease associated with immunocompromised states. We describe a case of PML, which developed after prolonged ibrutinib use and a low burden of chronic lymphocytic leukemia disease. The delay in diagnosis of the patient despite multiple presentations to medical providers across different facilities suggests that there is a lack of awareness of PML as a potential complication of ibrutinib. Treatments with postulated anti-John Cunningham polyomavirus agents and IL-2 were ineffective, likely due to the advanced state of the patient's disease. Although recent evidence indicates that ibrutinib may enhance cell-mediated immunity, consistent with elevated CD4+ and CD8+ T cells and appropriate T-cell response to mitogens in the patient, ibrutinib-mediated inhibition of the humoral function may contribute to PML pathogenesis. As the duration of ibrutinib use is often indefinite, and the number of indications for ibrutinib continues to grow, recognition and further evaluation of the link between PML and ibrutinib is warranted.",
keywords = "Chronic lymphocytic leukemia, Ibrutinib, Progressive multifocal leukoencephalopathy",
author = "David Hsiehchen and Arasaratnam, {Reuben Jonathan} and Karuna Raj and Froehlich, {Thomas W} and Larry Anderson",
year = "2018",
month = "10",
day = "1",
doi = "10.1159/000490617",
language = "English (US)",
volume = "95",
pages = "319--322",
journal = "Oncology",
issn = "0890-9091",
publisher = "UBM Medica Healthcare Publications",
number = "5",

}

TY - JOUR

T1 - Ibrutinib use complicated by progressive multifocal leukoencephalopathy

AU - Hsiehchen, David

AU - Arasaratnam, Reuben Jonathan

AU - Raj, Karuna

AU - Froehlich, Thomas W

AU - Anderson, Larry

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disease associated with immunocompromised states. We describe a case of PML, which developed after prolonged ibrutinib use and a low burden of chronic lymphocytic leukemia disease. The delay in diagnosis of the patient despite multiple presentations to medical providers across different facilities suggests that there is a lack of awareness of PML as a potential complication of ibrutinib. Treatments with postulated anti-John Cunningham polyomavirus agents and IL-2 were ineffective, likely due to the advanced state of the patient's disease. Although recent evidence indicates that ibrutinib may enhance cell-mediated immunity, consistent with elevated CD4+ and CD8+ T cells and appropriate T-cell response to mitogens in the patient, ibrutinib-mediated inhibition of the humoral function may contribute to PML pathogenesis. As the duration of ibrutinib use is often indefinite, and the number of indications for ibrutinib continues to grow, recognition and further evaluation of the link between PML and ibrutinib is warranted.

AB - Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disease associated with immunocompromised states. We describe a case of PML, which developed after prolonged ibrutinib use and a low burden of chronic lymphocytic leukemia disease. The delay in diagnosis of the patient despite multiple presentations to medical providers across different facilities suggests that there is a lack of awareness of PML as a potential complication of ibrutinib. Treatments with postulated anti-John Cunningham polyomavirus agents and IL-2 were ineffective, likely due to the advanced state of the patient's disease. Although recent evidence indicates that ibrutinib may enhance cell-mediated immunity, consistent with elevated CD4+ and CD8+ T cells and appropriate T-cell response to mitogens in the patient, ibrutinib-mediated inhibition of the humoral function may contribute to PML pathogenesis. As the duration of ibrutinib use is often indefinite, and the number of indications for ibrutinib continues to grow, recognition and further evaluation of the link between PML and ibrutinib is warranted.

KW - Chronic lymphocytic leukemia

KW - Ibrutinib

KW - Progressive multifocal leukoencephalopathy

UR - http://www.scopus.com/inward/record.url?scp=85055612782&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055612782&partnerID=8YFLogxK

U2 - 10.1159/000490617

DO - 10.1159/000490617

M3 - Article

C2 - 30045034

AN - SCOPUS:85055612782

VL - 95

SP - 319

EP - 322

JO - Oncology

JF - Oncology

SN - 0890-9091

IS - 5

ER -