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Table 10 Overview of routine CSF parameters and approximate frequency of pathological results in PML

From: S1 guidelines “lumbar puncture and cerebrospinal fluid analysis” (abridged and translated version)

Parameter1st diagnostic lumbar puncture for PMLFollow-up during therapy (IRIS) aComment
Cell number≤ 4/μL: 85%
≥ 5 - ≤ 50/μL: 10%
>  50/μL: 5%
May increase during IRISAlso dependent on the underlying disease and treatment.
Cell differentiationNormal or slightly activted. Lympho-monocytic Also dependent on the underlying disease and treatment.
Total protein/ Albumin quotientNormal: 50%
Slightly elevated: 30%
Severely elevated: 20%
  
Quantitative IgG-, IgA-, IgM-synthesisIgG > 0%: 25%
IgA > 0%: 0%
IgM > 0%: 0%
 Is highly dependent on the underlying diseaseb
OCBs42% b Highly dependent on the underlying diseaseb
JCPyV-PCRPositive: 70-80%May increase during IRIS before it normalizesAt first manifestation of PML:
Sensitivity: 60-90%
Specificity: 100%
  1. aEmpirical values from own experience due to the lack of published systematic data
  2. bValue from a study with primarily HIV-PML patients. In particular, the natalizumab-PML cases will show an intrathecal immunoglobulin synthesis and oligoclonal bands corresponding to the underlying multiple sclerosis