TY - JOUR
T1 - Progressive multifocal leukoencephalopathy after rituximab therapy in HIV-negative patients
T2 - A report of 57 cases from the Research on Adverse Drug Events and Reports project
AU - Carson, Kenneth R.
AU - Evens, Andrew M.
AU - Richey, Elizabeth A.
AU - Habermann, Thomas M.
AU - Focosi, Daniele
AU - Seymour, John F.
AU - Laubach, Jacob
AU - Bawn, Susie D.
AU - Gordon, Leo I.
AU - Winter, Jane N.
AU - Furman, Richard R.
AU - Vose, Julie M.
AU - Zelenetz, Andrew D.
AU - Mamtani, Ronac
AU - Raisch, Dennis W.
AU - Dorshimer, Gary W.
AU - Rosen, Steven T.
AU - Muro, Kenji
AU - Gottardi-Littell, Numa R.
AU - Talley, Robert L.
AU - Sartor, Oliver
AU - Green, David
AU - Major, Eugene O.
AU - Bennett, Charles L.
PY - 2009/5/14
Y1 - 2009/5/14
N2 - Rituximab improves outcomes for persons with lymphoproliferative disorders and is increasingly used to treat immune-mediated illnesses. Recent reports describe 2 patients with systemic lupus erythematosus and 1 with rheumatoid arthritis who developed progressive multifocal leukoencephalopathy (PML) after rituximab treatment. We reviewed PML case descriptions among patients treated with rituximab from the Food and Drug Administration, the manufacturer, physicians, and a literature review from 1997 to 2008. Overall, 52 patients with lymphoproliferative disorders, 2 patients with systemic lupus erythematosus, 1 patient with rheumatoid arthritis, 1 patient with an idiopathic autoimmune pancytopenia, and 1 patient with immune thrombocytopenia developed PMLafter treatment with rituximab and other agents. Other treatments included hematopoietic stem cell transplantation (7 patients), purine analogs (26 patients), or alkylating agents (39 patients). One patient with an autoimmune hemolytic anemia developed PMLafter treatment with corticosteroids and rituximab, and 1 patient with an autoimmune pancytopenia developed PML after treatment with corticosteroids, azathioprine, and rituximab. Median time from last rituximab dose to PML diagnosis was 5.5 months. Median time to death after PML diagnosis was 2.0 months. The case-fatality rate was 90%. Awareness is needed of the potential for PML among rituximab-treated persons.
AB - Rituximab improves outcomes for persons with lymphoproliferative disorders and is increasingly used to treat immune-mediated illnesses. Recent reports describe 2 patients with systemic lupus erythematosus and 1 with rheumatoid arthritis who developed progressive multifocal leukoencephalopathy (PML) after rituximab treatment. We reviewed PML case descriptions among patients treated with rituximab from the Food and Drug Administration, the manufacturer, physicians, and a literature review from 1997 to 2008. Overall, 52 patients with lymphoproliferative disorders, 2 patients with systemic lupus erythematosus, 1 patient with rheumatoid arthritis, 1 patient with an idiopathic autoimmune pancytopenia, and 1 patient with immune thrombocytopenia developed PMLafter treatment with rituximab and other agents. Other treatments included hematopoietic stem cell transplantation (7 patients), purine analogs (26 patients), or alkylating agents (39 patients). One patient with an autoimmune hemolytic anemia developed PMLafter treatment with corticosteroids and rituximab, and 1 patient with an autoimmune pancytopenia developed PML after treatment with corticosteroids, azathioprine, and rituximab. Median time from last rituximab dose to PML diagnosis was 5.5 months. Median time to death after PML diagnosis was 2.0 months. The case-fatality rate was 90%. Awareness is needed of the potential for PML among rituximab-treated persons.
UR - http://www.scopus.com/inward/record.url?scp=66549130454&partnerID=8YFLogxK
U2 - 10.1182/blood-2008-10-186999
DO - 10.1182/blood-2008-10-186999
M3 - Article
C2 - 19264918
AN - SCOPUS:66549130454
SN - 0006-4971
VL - 113
SP - 4834
EP - 4840
JO - Blood
JF - Blood
IS - 20
ER -