Progressive multifocal leukoencephalopathy: a report of three cases in HIV-negative patients with non-Hodgkin's lymphomas treated with rituximab

Tuccori, Marco; Focosi, Daniele; Maggi, Fabrizio; Cosottini, Mirco; Meini, Barbara; Lena, Fabio; Blandizzi, Corrado; Tacca, M. Del; Petrini, Mario

doi:10.1007/s00277-009-0819-2

Cited by 13 publications

(11 citation statements)

References 11 publications

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“…posed to rituximab and five cases in the exposed population. Details of these cases were published previously [6,7]. Four of the five cases of PML in the group exposed to rituximab were confirmed by the detection of JC virus (JCV) DNA in stereotactic brain biopsy samples (immunohistochemistry for JCV proteins was not requested at that time).…”

Section: Resultsmentioning

confidence: 96%

“…We recently reported six cases of PML in HIV Ϫ hematological patients (including five NHL cases) treated with rituximab at the Hematology Unit of the University Hospital of Pisa [6,7], establishing an incidence rate of 2.89 cases per 100,000 patient-years [8]. This value is about twofold higher than that reported for AIDS patients (the population traditionally carrying the highest risk for PML) in the late highly active antiretroviral therapy period [9].…”

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confidence: 86%

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Inclusion of Rituximab in Treatment Protocols for Non-Hodgkin's Lymphomas and Risk for Progressive Multifocal Leukoencephalopathy

Tuccori

Focosi²,

Blandizzi

et al. 2010

The Oncologist

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After completing this course, the reader will be able to:1. Evaluate the application of risk estimates of progressive multifocal leukoencephalopathy to your patients with non-Hodgkin's lymphoma previously treated with rituximab.2. Include progressive multifocal leukoencephalopathy in the differential diagnosis for neurological symptoms in your patients with non-Hodgkin's lymphoma previously treated with rituximab.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTObjectives. Rituximab is an anti-CD20 monoclonal antibody that promotes better treatment outcomes in patients with non-Hodgkin's lymphoma (NHL). Case series of progressive multifocal leukoencephalopathy

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Section: Resultsmentioning

confidence: 96%

mentioning

confidence: 86%

Inclusion of Rituximab in Treatment Protocols for Non-Hodgkin's Lymphomas and Risk for Progressive Multifocal Leukoencephalopathy

Tuccori

Focosi²,

Blandizzi

et al. 2010

The Oncologist

Self Cite

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show abstract

“…Cytarabine has been used by intrathecal or intravenous administration, since it has one of the highest in vitro activities against JC virus replication, but survival benefit could not be determined 1 2. Serotonin receptor antagonists have also been proposed as agents potentially blocking JC virus entry, since the serotonergic 5-HT2α receptor is discovered to be involved in JC virus internalisation into glial cells 10. However, evidence of efficacy is still scarce 2 10.…”

Section: Discussionmentioning

confidence: 99%

“…Serotonin receptor antagonists have also been proposed as agents potentially blocking JC virus entry, since the serotonergic 5-HT2α receptor is discovered to be involved in JC virus internalisation into glial cells 10. However, evidence of efficacy is still scarce 2 10. Mefloquine, an antimalarial drug, could inhibit JC virus replication in a cell culture system and might be effective 2.…”

Section: Discussionmentioning

confidence: 99%

Progressive multifocal leukoencephalopathy during treatment with rituximab and CHOP chemotherapy in a patient with a diffuse large B-cell lymphoma

Sikkema¹,

Schuiling

Hoogendoorn

2013

BMJ Case Reports

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SUMMARYA 74-year-old woman with a diffuse large B-cell lymphoma was treated with rituximab and CHOP chemotherapy. After three cycles of chemotherapy she developed progressive symptoms of motor imbalance, fatigue, weight loss and impaired cognitive function, which was interpreted as toxicity of the CHOP chemotherapy. The sixth cycle CHOP chemotherapy was withheld and three additional cycles of rituximab were given. Two weeks later, neurological symptoms appeared, including abducens nerve palsy of her left eye, ataxia and hemiparesis of her right body. MRI of the brain revealed two hyperintense lesions on T2-weighted and fluid-attenuated inversion recovery images without oedema or gadolinium enhancement. A PCR on John Cunningham (JC) virus DNA in cerebrospinal fluid was negative, but subsequent brain biopsy diagnosed progressive multifocal leukoencephalopathy (PML). She rapidly deteriorated and died. Awareness of PML during immunosuppressive therapy can be lifesaving, since only immune reconstitution can prevent mortality in these patients. BACKGROUND

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“…In general rituximab is well tolerated with the most common reported adverse effect being infusion reactions. Unfortunately a number of cases of PML have been identified in patients receiving rituximab [233–235], reminding us that treatments with improved efficacy can carry significant clinical risk.…”

Section: Emerging Disease Modifying Treatment In Rrmsmentioning

confidence: 99%

What Do Effective Treatments for Multiple Sclerosis Tell Us about the Molecular Mechanisms Involved in Pathogenesis?

Buzzard

Broadley

Butzkueven

2012

IJMS

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Multiple sclerosis is a potentially debilitating disease of the central nervous system. A concerted program of research by many centers around the world has consistently demonstrated the importance of the immune system in its pathogenesis. This knowledge has led to the formal testing of a number of therapeutic agents in both animal models and humans. These clinical trials have shed yet further light on the pathogenesis of MS through their sometimes unexpected effects and by their differential effects in terms of impact on relapses, progression of the disease, paraclinical parameters (MRI) and the adverse events that are experienced. Here we review the currently approved medications for the commonest form of multiple sclerosis (relapsing-remitting) and the emerging therapies for which preliminary results from phase II/III clinical trials are available. A detailed analysis of the molecular mechanisms responsible for the efficacy of these medications in multiple sclerosis indicates that blockade or modulation of both T- and B-cell activation and migration pathways in the periphery or CNS can lead to amelioration of the disease. It is hoped that further therapeutic trials will better delineate the pathogenesis of MS, ultimately leading to even better treatments with fewer adverse effects.

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Progressive multifocal leukoencephalopathy: a report of three cases in HIV-negative patients with non-Hodgkin's lymphomas treated with rituximab

Cited by 13 publications

References 11 publications

Inclusion of Rituximab in Treatment Protocols for Non-Hodgkin's Lymphomas and Risk for Progressive Multifocal Leukoencephalopathy

Inclusion of Rituximab in Treatment Protocols for Non-Hodgkin's Lymphomas and Risk for Progressive Multifocal Leukoencephalopathy

Progressive multifocal leukoencephalopathy during treatment with rituximab and CHOP chemotherapy in a patient with a diffuse large B-cell lymphoma

What Do Effective Treatments for Multiple Sclerosis Tell Us about the Molecular Mechanisms Involved in Pathogenesis?

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