Author Topic: (AAN)Tysabri-related PML w/recent negative JCV testing  (Read 110 times)

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Offline agate

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(AAN)Tysabri-related PML w/recent negative JCV testing
« on: April 27, 2015, 01:24:53 pm »
A rare instance of a discussion of a patient with Tysabri-related PML--this time in someone whose JCV testing was negative.

Presented at the annual AAN conference in Washington, DC:

Quote
P4.030] Natalizumab-Related PML Is Possible Even With Recent Negative JCV Antibody Testing


Marie-Sarah Brosseau, Gary Stobbe, Deb Cramer, Hillary Lipe, Annette Wundes
Seattle, WA, USA.

OBJECTIVE:

To describe a case of progressive multifocal leukoencephalopathy (PML) in a patient on natalizumab who's last John Cunningham virus (JCV) antibody testing 2 weeks before onset of symptoms was negative.

BACKGROUND:

Natalizumab-related PML has a mortality of 22%, but many survivors have a poor functional outcome. An important PML risk factor is seropositivity for anti-JCV antibodies and serology should be retested periodically. Previously, 2 natalizumab-treated multiple sclerosis PML patients were anti-JCV antibody negative but testing dated from 8 and 9 months before diagnosis.

DESIGN/METHODS:

Case presentation and literature review.

RESULTS:

A 70-year-old woman who had been on natalizumab for more than 4 years and had never received immunosuppressants developed PML symptoms of progressive right arm weakness 2 weeks after last negative anti-JCV antibody testing (index value 0.19). The initial brain MRI was reported as having a new MS lesion but short-term repeat MRI raised the concern for PML and CSF JCV PCR came back positive. While prior routine JCV antibody retesting every 3 months per our clinic standard had been negative until 2 weeks prior to onset of symptoms, at time of diagnosis serum anti-JCV antibody was positive with an index of 2.56.

CONCLUSIONS:

Negative anti-JCV antibody patients are still at risk for the development of PML because of the potential for de novo infection as well as possibly false negative test result, of which the reported rate is 3%.

This case reiterates that any natalizumab-treated patient with new MRI lesions or new symptoms could have PML and suggests that JCV antibody should be repeated even if recently negative. Moreover, in such cases, short-term repeat MRI and/or CSF testing warrants consideration.

________
Study Supported by: not supported
Category - MS and CNS Inflammatory Disease: Clinical Science

Session: P4: Poster Session IV: MS and CNS Inflammatory Diseases: Progressive Multifocal Leukoencephalopathy Risk (7:30 AM-12:00 PM)
Date/Time: Wednesday, April 22, 2015 - 7:30 am

The abstract can be seen here.
MS Speaks--online for 17 years

SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010. Glatopa (glatiramer acetate 40mg 3 times/week) since 12/16/20.