Natalizumab-induced PML: can the beast be tamed?
- 1Institute of Clinical Neuroimmunology, Ludwig Maximilians University, Munich, Germany
- 2Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
- Correspondence to Professor Reinhard Hohlfeld, Institute of Clinical Neuroimmunology, Klinikum der LMU München, Campus Grosshadern, Marchioninistr. 15, München D-81377, Germany;
- Received 8 February 2013
- Accepted 9 February 2013
- Published Online First 9 March 2013
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 …