Progressive multifocal leukoencephalopathy during 4 years of Palbociclib for advanced breast cancer with a history of follicular lymphoma patient.

in Journal of neurovirology by Ryosuke Koyamada, Mariko Nishihara, Tetsuhiro Masaki, Tomohito Shimada, Kazuhiro Ishikawa, Jun Hashimoto, Nobuyoshi Mori, Asami Namai, Hideaki Yokoo, Kenta Takahashi, Tadaki Suzuki, Kazuo Nakamichi, Shinichiro Mori

TLDR

  • A 67-year-old woman with a history of follicular lymphoma and breast cancer developed PML during treatment with fluvestrant and palbociclib, highlighting a possible association between palbociclib and PML.
  • The patient's survival for a year after diagnosis, despite discontinuing palbociclib, suggests potential benefits of stopping suspected causative agents in patients with PML.

Abstract

A 67-year-old woman with a history of follicular lymphoma and recurrent breast cancer with multiple metastasis developed PML during receiving fluvestrant plus palbociclib. Rituximab and bendamustine had finished 6.5 years ago. Discontinuing palbociclib and using mirtazapine, she is alive a year after diagnosis of PML. It is rare for PML to be diagnosed long after the last dose of rituximab and bendamustine. We will discuss the possible involvement of palbociclib in the course of PML.

Overview

  • The case report describes a 67-year-old woman with a history of follicular lymphoma and recurrent breast cancer who developed Progressive Multifocal Leukoencephalopathy (PML) during treatment with fluvestrant plus palbociclib.
  • The patient had previously received rituximab and bendamustine therapy 6.5 years ago, which is unusual for PML diagnosis.
  • The study aims to explore the possible role of palbociclib in the development and progression of PML.

Comparative Analysis & Findings

  • The patient developed PML during treatment with fluvestrant and palbociclib, which suggests a possible association between palbociclib and PML.
  • The rarity of PML diagnosis long after the last dose of rituximab and bendamustine therapy indicates the patient's unusual case.
  • Discontinuing palbociclib and using mirtazapine, the patient survived for a year after the diagnosis of PML, which suggests that stopping the suspected causative agent may be beneficial for patients with PML.

Implications and Future Directions

  • The findings highlight the importance of monitoring patients with PML during treatment with specific medications, such as palbociclib, for potential associations with disease progression.
  • Future studies may investigate the specificity and mechanisms of palbociclib-induced PML, including potential molecular targets and biomarkers.
  • The case report also underscores the need for early detection and diagnosis of PML, as well as development of effective treatments to improve patient outcomes.
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