CHARACTERISTICS OF LUPUS PATIENTS WITH PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY (PML)-LITERATURE REVIEW
Bibliographic record
Abstract
PV046 / #490 Poster Topic: AS05 - CNS Lupus Background/Purpose Progressive multifocal leukocencephalopathy (PML) is a potentially fatal degenerative condition caused by reactivation of the human polyomavirus 2 (John Cunningham-JC virus) in immunodeficient individuals. It has been observed in patients receiving Rituximab, but those treated with other immunosuppressants, such as systemic lupus erythematosus (SLE) patients, may be at risk as well. Methods A review of various online databases was conducted, with publications ranging from 1986 to 2024. 14 cases were selected for further analysis. Results Sex-12 female and 2 male; age-youngest 28 years, oldest 83 years. Initial SLE treatment: glucocorticoids (Prednisone, Prednisolone, IV Methylprednisolone)-all 14 patients; chloroquine/hydroxychloroquine (HCQ)-4/14; Mycophenolate mofetil (MMF)-6/14; Azathioprine (AZA)-5/14; IV Cyclophosphamide (CYC)-1/14; 6-mercaptopurin-1/14; Cyclosporin-2/14; Belimumab-2/14; anti interleukin 2 agent-1/14; Synachten-1/14; Dapsone-1/14; Plasmapheresis-1/14. Neurological symptoms: muscle weakness-5/14; hemiparesis-3/14; dysarthria-5/14; apraxia-3/14; gait disturbance-5/14; visual disturbances-4/14; cognitive disfunction-7/14; sensitive disfunction (anesthesia, hypoesthesia)-6/14; migraines-2/14. Comorbidities: lupus nephritis-2/14. Patients with SLE relapses: 4/14. Definitive diagnosis of PML-JC virus identification: cerebrospinal fluid (CSF)-6/14; brain biopsy-5/14; both-1/14; autopsy-2/14. PML management: stop all immunosuppresion-10/14; high dose IV Methylpred-nisolone-4/14; high dose iv Methylprednisolone+plasmapheresis-1/14; IV CYC-3/14; corticosteroids+AZA-1/14; immunoglobulins-1/14; Mefloquin-2/14; Cidofovir-2/14; Interferon-alpha-1/14; Levetiracetam-1/14; Mirtazapine-2/14; Citarabine-1/14; no treatment (advanced age)-2/14 Outcome: recovered with minimal deficits-3/14; recovered with sequelae-3/14; death-6/14; lost from monitoring-2/14PML management: stop all immunosuppresion-10/14; high dose IV Methylprednisolone-4/14; high dose iv Methylprednisolone+plasmapheresis-1/14; IV CYC-3/14; corticosteroids+AZA-1/14; immunoglobulins-1/14; Mefloquin-2/14; Cidofovir-2/14; Interferon-alpha-1/14; Levetiracetam-1/14; Mirtazapine-2/14; Citarabine-1/14; no treatment (advanced age)-2/14. Outcome: recovered with minimal deficits-3/14; recovered with sequelae-3/14; death-6/14; lost from monitoring-2/14. Conclusions There was correlation found between initial immunosuppression with MMF and subsequent stopping and better outcomes, as well as worse outcomes in patients that initially received AZA and those that afterwards received a combination of steroids and AZA or CYC. There was no correlation found between age and outcome. Although rare, PML must be taken into consideration in SLE patients presenting with neurological symptoms that don’t respond to conventional treatment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.009 | 0.012 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".