接受那他珠单抗治疗后发生进行性多灶性白质脑病（PML）并随后接受多发性硬化症（MS）治疗的幸存者：临床影像学结果
Natalizumab-PML survivors with subsequent MS treatment: Clinico-radiologic outcome.
作者信息
Maillart Elisabeth, Vidal Jean-Sebastien, Brassat David, Stankoff Bruno, Fromont Agnès, de Sèze Jérôme, Taithe Frédéric, Clavelou Pierre, Bourre Bertrand, Delvaux Valérie, Rico Audrey, Labauge Pierre, Tourbah Ayman, Lebrun Christine, Pelletier Jean, Moreau Thibault, Louapre Céline, Lubetzki Catherine, Papeix Caroline
机构信息
Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France.
出版信息
Neurol Neuroimmunol Neuroinflamm. 2017 Apr 14;4(3):e346. doi: 10.1212/NXI.0000000000000346. eCollection 2017 May.
OBJECTIVE
To describe the clinico-radiologic outcome of MS patients with natalizumab-related progressive multifocal leukoencephalopathy (Nz-PML) surviving and receiving disease-modifying therapy (DMT).
METHODS
We describe clinical and radiologic evolution of Nz-PML survivors in an observational retrospective multicenter cohort to clarify the effect of different subsequent MS DMT strategies. Twenty-three patients from 11 centers were analyzed. Outcomes were (1) clinical efficacy of post-PML MS DMT, (2) radiologic efficacy of post-PML MS DMT, (3) radiologic evolution of PML lesion, and (4) disability progression.
RESULTS
There was no clinical worsening of PML symptoms with a stability of Expanded Disability Status Scale at the last follow-up. No relapse was reported with fingolimod and dimethyl fumarate. No radiologic worsening of Nz-PML lesion was observed at the end of the follow-up.
CONCLUSION
In this large cohort of patients with Nz-PML, MS therapies given after Nz discontinuation were not associated with PML worsening. A larger cohort with longer follow-up will be necessary to confirm this therapeutic strategy.
目的
描述接受疾病修正治疗（DMT）的那他珠单抗相关进行性多灶性白质脑病（Nz-PML）存活多发性硬化症（MS）患者的临床放射学结局。
方法
我们在一项观察性回顾性多中心队列研究中描述Nz-PML幸存者的临床和放射学演变，以阐明不同后续MS DMT策略的效果。分析了来自11个中心的23例患者。结局指标包括：（1）PML后MS DMT的临床疗效；（2）PML后MS DMT的放射学疗效；（3）PML病变的放射学演变；（4）残疾进展情况。
结果
在最后一次随访时，PML症状无临床恶化，扩展残疾状态量表保持稳定。使用芬戈莫德和富马酸二甲酯未报告复发。随访结束时未观察到Nz-PML病变的放射学恶化。
结论
在这个大型Nz-PML患者队列中，停用Nz后给予的MS治疗与PML恶化无关。需要更大规模且随访时间更长的队列来证实这一治疗策略。
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