Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Treatment schedules for 5-HT2A blocking in progressive multifocal leukoencephalopathy using risperidone or ziprasidone

Bone Marrow Transplantation volume 39, pages 811–812 (2007)Cite this article

We note with regret the failure of ziprasidone in the progressive multifocal leukoencephalopathy (PML) patient recently reported by Kharfan-Dabaja et al.1 The authors point out the rarity of allogeneic hematopoietic stem cell transplant (HSCT) recipient survival in biopsy-proven PML. Our recent report of such a survival2 appeared as their report went to print. We treated a 33-year-old female recipient of a haploidentical HSCT in terminal coma and biopsy-proven PML with 14 days of the serotonin 2A (5-HT2A) antagonist risperidone at 4 mg p.o. (orally) twice daily. She recovered promptly, continues to do well with moderate residual brain damage but functions well emotionally, in relationships, mobility, and self care.

Psychiatry has long had great interest in the 5-HT2A receptor and many safe medicines are on the market to block this receptor. The causative agent of PML, the JC virus (JCV), was shown to use the 5-HT2A receptor to enter cells3 and 5-HT2A blocking drugs were suggested as treatment for PML.3, 4 The following note outlines our current thoughts on treatment of PML using FDA-approved 5-HT2A blockers (see Table 1).

Table 1 Selected characteristics of drugs that can be considered for further research in the treatment of PML by 5-HT2A receptor blockade after p.o. intake
Full size table

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Kharfan-Dabaja MA, Ayala E, Greene J, Rojiani A, Murtagh FR, Anasetti C . Two cases of progressive multifocal leukoencephalopathy after allogeneic hematopoietic cell transplantation and a review of the literature. Bone Marrow Transplant 2007; 39: 253–254.

    Article  Google Scholar 

  2. Focosi D, Fazzi R, Montanaro D, Emdin M, Petrini M . Progressive multifocal leukoencephalopathy in a haploidentical stem cell transplant recipient: a clinical, neuroradiological and virological response after treatment with risperidone. Antiviral Res 2007; 74: 156–158.

    Article  CAS  Google Scholar 

  3. Elphick GF, Querbes W, Jordan JA, Gee GV, Eash S, Manley K et al. The human polyomavirus, JCV, uses serotonin receptors to infect cells. Science 2004; 306: 1380–1383.

    Article  CAS  Google Scholar 

  4. Altschuler EL, Kast RE . The atypical antipsychotic agents ziprasidone, risperdone and olanzapine as treatment for and prophylaxis against progressive multifocal leukoencephalopathy. Med Hypotheses 2005; 65: 585–586.

    Article  CAS  Google Scholar 

  5. Fischman AJ, Bonab AA, Babich JW, Alpert NM, Rauch SL, Elmaleh DR et al. Positron emission tomographic analysis of central 5-hydroxytryptamine 2 receptor occupancy in healthy volunteers treated with the novel antipsychotic agent, ziprasidone. J Pharmacol Exp Ther 1996; 279: 939–947.

    CAS  PubMed  Google Scholar 

  6. Nyberg S, Dahl ML, Halldin C . A PET study of D2 and 5-HT2 receptor occupancy induced by risperidone in poor metabolizers of debrisoquin and risperidone. Psychopharmacology (Berl) 1995; 119: 345–348.

    Article  CAS  Google Scholar 

  7. Mannens G, Huang ML, Meuldermans W, Hendrickx J, Woestenborghs R, Heykants J . Absorption, metabolism, and excretion of risperidone in humans. Drug Metab Dispos 1993; 21: 1134–1141.

    CAS  PubMed  Google Scholar 

  8. Rossi A, Delbue S, Mazziotti R, Valli M, Borghi E, Mancuso R et al. Presence, quantitation and characterization of JC virus in the urine of Italian immunocompetent subjects. J Med Virol 2007; 79: 408–412.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, University of Vermont, Burlington, VT, USA

    R E Kast

  2. Division of Hematology, Azienda Ospedaliera Santa Chiara, University of Pisa, Pisa, Italy

    D Focosi & M Petrini

  3. Department of Physical Medicine, UMDNJ, Newark, NJ, USA

    E L Altschuler

Authors
  1. R E Kast
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D Focosi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Petrini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E L Altschuler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R E Kast.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kast, R., Focosi, D., Petrini, M. et al. Treatment schedules for 5-HT2A blocking in progressive multifocal leukoencephalopathy using risperidone or ziprasidone. Bone Marrow Transplant 39, 811–812 (2007). https://doi.org/10.1038/sj.bmt.1705682

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1705682

This article is cited by

Search

Advanced search

Quick links