Natalizumab-Associated Primary Central Nervous System Lymphoma

Menarvia Nixon, Richard P. Menger, Piyush Kalakoti, Jai Deep Thakur, Rimal H. Dossani, Kanika Sharma, Anil Nanda, Bharat Guthikonda

Research output: Contribution to journalReview articlepeer-review

11 Scopus citations

Abstract

Objective Natalizumab, a selective adhesion molecule inhibitor binding to an α-4 subunit of integrin, has emerged to be an effective immunomodulator, especially in the treatment of relapsing-remitting multiple sclerosis and Crohn disease. Recent reports documenting the development of primary central nervous system lymphoma (PCNSL) as a result of its administration have been concerning, and they trigger a debate about a possible causal association. In our report, we provide a comprehensive review of the literature on lymphoma development after natalizumab use, and we report an additional case of PCNSL development in a young woman who received natalizumab for her Crohn disease. Methods A systematic (qualitative) review of literature on lymphoma development after natalizumab therapy was performed by use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data on patient characteristics, indication for drug therapy, dosages, radiologic findings, potential risk factors for PCNSL, and tumor markers were synthesized. Additionally, we present the findings from the case of a young woman who received natalizumab therapy (4 doses, 300 mg each) for Crohn disease and in whom PCNSL developed. Results Overall, 8 reports including our index case document lymphoma development after natalizumab use. Our case finding revisits the debate suggesting a remote possibility of association that warrants further evaluation and validation. Conclusions Evidence documenting a causal association of natalizumab and PCNSL is weak. Considering the potential benefits of using natalizumab for current indications, we recommend vigilant monitoring of patients receiving the drug for PCNSL outlook.

Original languageEnglish (US)
Pages (from-to)152-159
Number of pages8
JournalWorld Neurosurgery
Volume109
DOIs
StatePublished - Jan 2018
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Keywords

  • Central nervous system
  • Craniotomy
  • Crohn disease
  • Lymphoma
  • Multiple sclerosis
  • Natalizumab
  • Tsyabri

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