Diagnosis and treatment of progressive multifocal leukoencephalopathy

Abstract

Progressive multifocal leukoencephalopathy (PML) is a rare but a very serious complication associated inter alia with the use of new biological and immunomodulatory agents that cause long-lasting immunosuppression. This also applies to rituximab, commonly used for treatment of B-cell non-Hodgkin lymphoma (NHL) patients. PML may develop during, as well as after, completion of treatment with rituximab. Diagnosis of PML is not easy and poses a significant challenge for the clinician due to similarity of symptoms that occur with lymphoma infiltration of central nervous system (CNS). The paper summarizes the most recent information on the epidemiology, clinical course and treatment of PML with particular attention to patients with NHL. It also discusses recommendations of the American Academy of Neurology, published in April 2013, on the diagnosis and detection of PML in the context of their use in everyday clinical practice.