Edahiro Taro, Fukushima Noriyasu, Otani Tatsuya, Nakamori Masahiro, Nakamichi Kazuo, Chishaki Ren, Fujino Keita, Mino Tatsuji, Yoshida Tetsumi, Sugihara Sayaka, Nishizawa Masatoshi, Ichinohe Tatsuo
Department of Hematology and Oncology, Hiroshima University, Hiroshima, Japan.
Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
Acta Haematol. 2022;145(6):655-661. doi: 10.1159/000526132. Epub 2022 Jul 27.
Progressive multifocal leukoencephalopathy (PML) is a rare neurological disease caused by the reactivation of latent John Cunningham polyomavirus. Hematological disorders associated with immunomodulatory monoclonal antibodies and hematopoietic stem cell transplantation (HSCT) are risk factors for PML. Blinatumomab is a novel antileukemic immunomodulatory agent and more effective for relapsed and refractory acute lymphoblastic leukemia (ALL) than conventional chemotherapy. But, blinatumomab suppresses humoral immunity due to long-lasting B-cell depletion during and after the treatment. The development of PML involves cellular immunity and impairment of humoral immunity. Although few cases of blinatumomab-related PML have been reported, the use of blinatumomab after allogeneic HSCT may increase the risk of developing PML. The current case report presents a patient of Philadelphia chromosome-positive ALL wherein PML developed after cord blood stem cell transplantation and administrating blinatumomab.
进行性多灶性白质脑病（PML）是一种由潜伏的约翰·坎宁安多瘤病毒重新激活引起的罕见神经系统疾病。与免疫调节性单克隆抗体和造血干细胞移植（HSCT）相关的血液系统疾病是PML的危险因素。博纳吐单抗是一种新型抗白血病免疫调节药物，对复发和难治性急性淋巴细胞白血病（ALL）比传统化疗更有效。但是，博纳吐单抗在治疗期间和治疗后会导致持久的B细胞耗竭，从而抑制体液免疫。PML的发生涉及细胞免疫和体液免疫受损。虽然与博纳吐单抗相关的PML病例报道较少，但异基因HSCT后使用博纳吐单抗可能会增加发生PML的风险。本病例报告介绍了一名费城染色体阳性ALL患者，其在脐带血干细胞移植并使用博纳吐单抗后发生了PML。
