Progressive Multifocal Leukoencephalopathy After Allogeneic Bone Marrow Transplantation for Acute Myeloid Leukemia

Abstract

Progressive multifocal leukoencephalopathy (PML) is a rare fatal complication of allogeneic bone marrow transplantation (BMT) resulting from chronic immunosuppression and impaired cellular immunity. This report discusses 2 cases of PML in patients with acute myeloid leukemia after allogeneic BMT. Diagnosis was made based on characteristic brain MRI findings and positive PCR results for John Cunningham virus in the cerebrospinal fluid. Unfortunately, therapeutic options are limited and nearly always result in terminal outcomes. Although immunosuppression is an unavoidable risk of allogeneic BMT, these cases highlight a rare, yet fatal, consequence of prolonged T-cell lymphopenia and impaired cellular immunity after allogeneic BMT in this patient population. (J Natl Compr

Progressive Multifocal Leukoencephalopathy in Relapsed Ph+ Acute Lymphoblastic Leukemia after Cord Blood Transplantation and Blinatumomab Treatment: A Case Report and Literature Review

“…We reviewed previous reports of PML after allogeneic HSCT. The time of onset of PML varied from a minimum of 2 months to a maximum of 105 months after transplantation [11, 12]. There was no significant correlation between the onset time and donor type or disease.…”

“…In particular, B-cell depletion was sustained throughout the treatment cycles 1 and 2 in patients achieving minimal residual disease negative [13]. In the long term, serum levels of IgG and other immunoglobulin subclasses continue to decrease [12]. Hypogammaglobulinemia was observed more frequently in the Blin group (6%) than in the conventional chemotherapy group (0.9%) in a phase 3 TOWER study [2].…”

Progressive multifocal leukoencephalopathy after allogeneic stem cell transplantation: Case report and review of the literature

“…At present, 28 cases of PML have been reported in the English literature in patients who have undergone an allogeneic stem cell transplantation from 1958 to 2016 (Table ) . The median age of patients was 43 years (range: 14‐77 years), and the time to the manifestation of symptoms ranged from 1 to 60 months (median: 8 months).…”

The confused oncologic patient: a rational clinical approach

“…77–79 In addition, it is increasingly recognized as a complication of allogeneic HSCT due to chronic immunosuppression needed to prevent graft versus host disease. 80 Although brain biopsy is the gold standard for diagnosis, detection of JC virus in the CSF in association with typical white matter changes on neuroimaging is sufficient to confirm the diagnosis; however, the sensitivity of CSF PCR for JC virus is only 75% so in patients where PML is considered likely, a brain biopsy may still be necessary for diagnosis. 77,81 Reconstitution of immune function is the only known treatment.…”