Table 1.
Overview of currently discussed treatment options in PML.
| Treatment approach | Mechanism of action | Outcome (Source) |
|---|---|---|
| Cytarabin | Nucleotide analogue | No improvement in survival rate compared to no cytarabin (p=0.85) (29) |
| Cidofovir | Nucleotide analogue | Decrease of survival in cidofovir group (30) No improvement in cidofovir group (HR 0.93, CI 0.66-1.32) (31) |
| Topotecan | Inhibitor of topoisomerase I | Treatment response in 3 of 12 patients, hematologic side effects (32) |
| Mirtazapine | Invasion block of JCV into oligodendrocytes by antagonism of 5HT2/5HT3 serotonin receptors | Anecdotal improvements in several cases, mostly in combination with antiviral therapy in HIV-positive individuals (33–38) |
| Mefloquine | Unknown | In-vitro inhibition of JC Virus replication, no benefit in DNA load in vivo (39, 40) |
| Interleukin-7 | Immunostimulation to increase lymphocyte count | Increase in lymphocytes and decrease in JCV viral load, but no clear improvement in 1-year-survival rate (54.7%) (41) |
| Filgrastim | Granulocyte colony stimulation factor | 100% survival 2 years after PML onset, retrospective study (42) |
| Checkpoint inhibitor (CPI) | Upregulation of activity of cytotoxic T cells | Improvement in up to 62.5% of cases, but case of PML onset under CPI therapy (26, 43) |
| Autologous or allogeneic T cells | HLA-matched transfer of immunocompetent T cells | Survival rates of up to 67% (44, 45) |
According to UpToDate (as of June 16th 2022) following treatment approaches are theoretically considered for PML therapy because of hypothetical mechanisms in small numbers of patients, but without clear proof of efficiency, whereof most agents have been studied in HIV positive individuals (46).