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Natalizumab-induced PML: can the beast be tamed?
  1. Reinhard Hohlfeld1,2
  1. 1Institute of Clinical Neuroimmunology, Ludwig Maximilians University, Munich, Germany
  2. 2Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
  1. Correspondence to Professor Reinhard Hohlfeld, Institute of Clinical Neuroimmunology, Klinikum der LMU München, Campus Grosshadern, Marchioninistr. 15, München D-81377, Germany; reinhard.hohlfeld{at}med.uni-muenchen.de

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Professor Ralf Gold and his team1 report on a cohort of 15 patients with natalizumab-associated progressive multifocal leucoencephalopathy (PML) who were treated at the university hospital of Bochum, Germany. This is the largest PML series from a single institution reported so far. It comprises almost 5% of the total PML cases presently known worldwide. The most remarkable observation is that none of the patients died during 21.5 months of median follow-up. By contrast, the overall lethality of natalizumab-associated PML is currently about 20%. What can we learn from these findings?

  • 1. The earlier PML is diagnosed, the better the prognosis. In the Bochum series, the mean interval from the first clinical and/or MRI evidence to the definite diagnosis by John Cunningham virus (JCV)-DNA detection in the cerebrospinal fluid (CSF) was 30 days. In …

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