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Miskin, Dhanashri P.

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Miskin

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Dhanashri P.

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Miskin, Dhanashri P.

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20162

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Author's Publications: search.filters.isAuthorOfPublication.5952160a-3f8b-4c00-bccd-25a4c2bab668

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Now showing 1 - 2 of 2
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    Interleukin-7 treatment of PML in a patient with idiopathic lymphocytopenia
    (Lippincott Williams & Wilkins, 2016) Miskin, Dhanashri P.; Chalkias, Spyridon G.; Dang, Xin; Bord, Evelyn; Batson, Stephanie; Koralnik, Igor J.
    Objective: To describe the compassionate use of interleukin-7 (IL-7) for treatment of progressive multifocal leukoencephalopathy (PML) in the setting of idiopathic CD8+ greater than CD4+ lymphocytopenia. Methods: A 66-year-old HIV-seronegative man presented with progressive language dysfunction. MRI showed hyperintense lesions in the left hemispheric white matter with mild contrast enhancement. A brain biopsy performed 4 months after symptom onset established the diagnosis of PML. The patient had profound lymphocytopenia with absolute lymphocyte count (ALC) at 168 cells/μL, 87 CD4+ T cells/μL, and 7 CD8+ T cells/μL. There was no evidence of hematologic malignancy or rheumatologic disease. Results: The patient received 3 intramuscular injections of IL-7 at a dose of 10 μg/kg per week with no adverse effects. ALC peaked at 595 cells/μL, CD4+ T cells at 301 cells/μL, and CD8+ T cells at 34 cells/μL 3 weeks after completion of treatment. His lesions on MRI stabilized and neurologic examination mildly improved. JCV-specific T-cell responses measured by intracellular cytokine staining were not altered after treatment with IL-7 but there was a marked increase in regulatory T cells. Conclusion: This case further supports the investigational use of IL-7 in patients who develop PML in the setting of ICL. Classification of evidence: This study provides Class IV evidence that for patients with ICL and PML, IL-7 improves PML-related-outcomes. The study is rated Class IV because it is a case report.
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    Diagnostic delay in progressive multifocal leukoencephalopathy
    (John Wiley and Sons Inc., 2016) Miskin, Dhanashri P.; Ngo, Long; Koralnik, Igor J.
    Abstract We investigated delay in diagnosing progressive multifocal leukoencephalopathy (PML). The median time from initial symptom to diagnosis was 74 days (range 1–1643) in 111 PML patients seen at our institution from 1993 to 2015. Another diagnosis was considered before PML in nearly two–thirds, and more than three–quarters of patients suffered from diagnostic delay greater than 1 month, irrespective of their underlying immunosuppressive condition. Extended diagnostic delay occurred more frequently in patients with possible PML, and among HIV + patients with higher CD4+ T‐cell counts at symptom onset. Prompt diagnosis may improve survival of PML in so far as immune reconstitution can be effected, and prevent unnecessary interventions.