Posterior leukoencephalopathy after combination chemotherapy in a patient with lymphoma

Abstract

Posterior leukoencephalopathy syndrome is a recently described syndrome involving mainly parieto-occipital gray/white matter of the brain. It occurs secondary to various clinical entities, like hypertension and immunosuppressive therapy. Few cases after combination chemotherapy have been reported. This study describes a 36-year-old woman with primary refractory T-cell lymphoma, who developed central nervous system toxicity due to treatment with intrathecal methotrexate and intravenous ifosfamide, idarubicine and etoposide given as a salvage regimen. Both clinical features as well as magnetic resonance imaging findings were typical for posterior leukoencephalopathy syndrome. The patient died despite anti-hypertensive therapy and haemodialysis. Central nervous system toxicity related to chemotherapeutics and posterior leukoencephalopathy syndrome are discussed briefly.

Posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia: Clinical characteristics, risk factors, course, and outcome of disease

“…Dexamethasone has previously been reported to be associated with PRES in cancer treatment, but data are scarce . Several other chemotherapeutic agents used in the treatment of ALL have also been associated with PRES, most likely through cytotoxic mechanisms . Increasing data indicate that hyponatremia might contribute to the pathogenesis of PRES .…”

Rearrangement of the JC virus regulatory region sequence in the bone marrow of a patient with rheumatoid arthritis and progressive multifocal leukoencephalopathy

“…PML should therefore be differentiated from a unique type of necrotizing leukoencephalopathy (Oka et al , 2003) and from reversible posterior leukoencephalopathy (Abali et al , 2005) that may rarely be toxic manifestations of methotrexate therapy.…”

Gliomatosis Cerebri Mimicking Chemotherapy-Induced Leukoencephalopathy in a Patient with non-Hodgkin's Lymphoma

“…Tensor tractography may be useful in visualizing the spread of GC which may otherwise not be seen with conventional MRI sequences (23). Temozolomide was shown to be effective in prolonging the survival in onethird of patients with GC (24 (1,3,6,8). Unlike CHOP chemotherapy (16), toxic leukoencephalopathy associated with MACOP-B regimen has never been reported in literature (25).…”

“…MRI is the imaging modality of choice for the differential diagnosis of white matter lesions that develop in patients with hematological malignancies (1,3,6,8). In addition to multifocal hyperintense spots both on T2-and FLAIR sequences, hyperintensity on DWI sequence seems to be indicative of toxic leukoencephalopathy (15).…”

“…Leukoencephalopathy is a rare but well-known complication of the intensive chemotherapy in such patients. Recently, reports on chemotherapy-induced, or "toxic" leukoencephalopathy have increased (1)(2)(3)(4)(5)(6)(7)(8) (2,3,5,6,8) Fig. 2A- (9,10 (1,3,6,8), other agents, including 5-fluorouracil and its derivative carmofur, and monoclonal antibodies have also been reported to cause the neurotoxicity (12,13).…”