Sustained Response and Rationale of Programmed Cell Death-1-Targeting for Progressive Multifocal Leukoencephalopathy

Alexandra Audemard-Verger; Jacques Gasnault; Maxime Faisant; Marie-Catherine Besse; Nicolas Martin-Silva; Mado Berra; Luc Fournier; Jonathan Boutemy; Gwenola Maigne; Hubert De Boysson; Alexis Ruet; Astrid Vabret; Françoise Chapon; Guillaume Martin-Blondel; Achille Aouba

doi:10.1093/ofid/ofz374

Sustained Response and Rationale of Programmed Cell Death-1-Targeting for Progressive Multifocal Leukoencephalopathy

Open Forum Infect Dis. 2019 Sep 30;6(10):ofz374. doi: 10.1093/ofid/ofz374. eCollection 2019 Oct.

Authors

Alexandra Audemard-Verger^{1

2}, Jacques Gasnault^{1

3}, Maxime Faisant⁴, Marie-Catherine Besse¹, Nicolas Martin-Silva¹, Mado Berra⁵, Luc Fournier⁶, Jonathan Boutemy¹, Gwenola Maigne¹, Hubert De Boysson¹, Alexis Ruet⁷, Astrid Vabret⁸, Françoise Chapon⁴, Guillaume Martin-Blondel⁹, Achille Aouba¹

Affiliations

¹ Department of Internal Medicine and Clinical Immunology, CHU de Caen, Caen, France.
² Normandy University, Caen, France.
³ Department of Internal Medicine and Clinical Immunology, Unit of Neuroviral Diseases, CHU de Bicetre, Le Kremlin-Bicetre, France.
⁴ Department of Pathology, CHU de Caen, Caen, France.
⁵ Department of Neurology, CHU de Caen, Caen, France.
⁶ Department of Radiology, CHU de Caen, Caen, France.
⁷ Department of Physical and Rehabilitation Medicine, CHU de Caen, Caen, France.
⁸ Department of Virology, CHU de Caen, Caen, France.
⁹ Department of Infectious Diseases, CHU de Purpan, Toulouse, France.

Abstract

In this study, we report a complete (clinical, radiological, and virological) sustained (1 year) response after nivolumab salvage therapy in a progressive multifocal leukoencephalopathy patient. Analyses of the cells infiltrate in a pretreatment brain biopsy suggest that parenchymal programmed cell death-L1⁺ macrophages could be the T-cells partnership in immune exhaustion and virus escape.

Keywords: JC virus; PD-1; immune checkpoint inhibitor; nivolumab; progressive multifocal leukoencephalopathy.