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

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

Parameter	1st diagnostic lumbar puncture for PML	Follow-up during therapy (IRIS) ^a	Comment
Cell number	≤ 4/μL: 85% ≥ 5 - ≤ 50/μL: 10% > 50/μL: 5%	May increase during IRIS	Also dependent on the underlying disease and treatment.
Cell differentiation	Normal or slightly activted. Lympho-monocytic		Also dependent on the underlying disease and treatment.
Total protein/ Albumin quotient	Normal: 50% Slightly elevated: 30% Severely elevated: 20%
Quantitative IgG-, IgA-, IgM-synthesis	IgG > 0%: 25% IgA > 0%: 0% IgM > 0%: 0%		Is highly dependent on the underlying disease^b
OCBs	42% ^b		Highly dependent on the underlying disease^b
JCPyV-PCR	Positive: 70-80%	May increase during IRIS before it normalizes	At first manifestation of PML: Sensitivity: 60-90% Specificity: 100%

^aEmpirical values from own experience due to the lack of published systematic data
^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

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