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Outcome of Progressive Multifocal Leukoencephalopathy Treated by Interleukin‐7

Abstract : Objective: Restoring anti-JC virus (JCV) immunity is the only treatment of progressive multifocal leukoencephalopathy (PML). Interleukin-7 is a cytokine that increases number and function of T cells. We analyzed a population of PML patients who received recombinant human IL-7 (rhIL-7) to estimate survival and its determinants. Methods: After exclusion of patients with missing data or receiving other immunotherapies, findings from 64 patients with proven PML who received rhIL-7 between 2007 and 2020 were retrospectively analyzed. Logistic regression was used to analyze variables associated with one-year survival. Results: Underlying conditions were HIV/AIDS (n = 27, 42%), hematological malignancies (n = 16, 25%), primary immunodeficiencies (n = 13, 20%), solid organ transplantation (n = 4, 6%) and chronic inflammatory diseases (n = 4, 6%). One-year survival was 54.7% and did not differ by underlying condition. Survival was not associated with baseline characteristics, but with a >50% increase in blood lymphocytes (OR 4.1, 95%CI 1.2-14.9) and CD4+ T cells (OR 5.9, 95%CI 1.7-23.3), and a > 1 log copies/mL decrease in cerebrospinal fluid JCV DNA (OR 7.6, 95%CI 1.6-56.1) during the first month after rhIL-7 initiation. Side effects were mainly local and flu-like symptoms (n = 8, 12.5%) and PML-immune reconstitution inflammatory syndrome (IRIS) (n = 5, 8%). Interpretation: In this non-controlled retrospective study, survival did not differ from that expected in HIV/AIDS patients, but might have been improved in those with hematological malignancies, primary immunodeficiencies and transplant recipients. RhIL-7 might have contributed to the increase in blood lymphocytes and decrease in CSF JCV replication that were associated with better survival. ANN NEUROL 2022;91:496-505.
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https://hal-univ-rennes1.archives-ouvertes.fr/hal-03780669
Contributor : Laurent Jonchère Connect in order to contact the contributor
Submitted on : Monday, September 19, 2022 - 3:49:40 PM
Last modification on : Wednesday, November 23, 2022 - 1:11:39 PM

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Rébecca Lajaunie, Ilaria Mainardi, Jacques Gasnault, Vanessa Rousseau, Andrea Tarantino, et al.. Outcome of Progressive Multifocal Leukoencephalopathy Treated by Interleukin‐7. Annals of Neurology, 2022, 91 (4), pp.496-505. ⟨10.1002/ana.26307⟩. ⟨hal-03780669⟩

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