Progressive Multifocal Leukoencephalopathy After Autologous Bone Marrow Transplantation in a Patient with Chronic Myelogenous Leukemia

Progressive multifocal leukoencephalopathy (PML) is a rare subacute demyelinating disorder of the central nervous system (CNS) caused by the DNA JC human polyomavirus. In immunocompromised hosts, PML is caused by reactivation of a latent infection rather than de novo primary exposure. PML in the setting of hematopoietic cell transplantation (HCT) is exceedingly rare. PML should be considered in the differential diagnosis of HCT recipients, autologous or allogeneic, presenting with worsening of neurological symptoms, especially associated with post-transplant neurodegenerative findings. Although DNA polymerase chain reaction (PCR) of the cerebrospinal fluid (CSF) has emerged as a promising tool for detecting JC virus, a negative result does not rule out PML. Brain biopsy remains the most reliable and accurate method for diagnosing JC virus-associated PML. Presently, there is no universally effective antiviral therapy against JC virus and outcome is fatal in the majority of cases. We hereby describe two cases of PML developing after allogeneic HCT and provide a comprehensive review of the literature.

“…There are eight reported cases of PML after autologous HCT [17][18][19][20][21][22][23] (Table 2). The median age of autograft recipients was 44 years (range: 31-60).…”

Section: Discussionmentioning

confidence: 99%

Two cases of progressive multifocal leukoencephalopathy after allogeneic hematopoietic cell transplantation and a review of the literature

Kharfan‐Dabaja

Ayala

Greene

et al. 2006

“…[3][4][5][6][7][8][9] The main characteristics of these cases are summarized in Table 1. Five patients received autologous transplants, and two allogeneic SCTs from matched unrelated donors.…”

Section: Discussionmentioning

confidence: 99%

“…So far, PML has been reported in seven cases after SCT. [3][4][5][6][7][8][9] Here, we report a case after autologous transplant for nonHodgkin's lymphoma treated with cidofovir. This case is the first case of PML after SCT treated with this antiviral agent.…”

mentioning

confidence: 99%

Progressive multifocal leukoencephalopathy after stem cell transplantation, unsuccessfully treated with cidofovir

Osorio

Cámara

Golbano

et al. 2002

Summary:We report a patient with progressive multifocal leukoencephalopathy (PML) after autologous stem cell transplantation (SCT) for non-Hodgkin's lymphoma (NHL). This is an unusual association, and to date only seven cases have been reported. This is the first case of PML after SCT treated with cidofovir, and the fifth case treated with this drug in a patient without human immunodeficiency virus (HIV) infection. In the previous four patients treated with cidofovir the outcome was discouraging, as was the case in this patient.

“…Thus, PML has been recognized with increasing frequency in HIV-infected patients 6 but there are also documented cases of PML in patients with lymphoma [7][8][9] or following bone marrow transplantation (BMT). 10,11 We report the case of a patient with mantle cell lymphoma and non-HIV-associated PML 1 year after autologous BMT.…”

mentioning

confidence: 99%

Progressive multifocal leukoencephalopathy after autologous bone marrow transplantation and alpha-interferon immunotherapy

Ré

Bamborschke

Feiden

et al. 1999

Summary:A patient with a stage IV mantle cell lymphoma (according to the REAL classification) was treated with high-dose chemotherapy and autologous bone marrow transplantation. One year later while on alpha-interferon immunotherapy she suffered from progressive loss of short-term memory and reported difficulties in recognizing objects. Magnetic resonance imaging (MRI) showed a vast ring-enhancing lesion of the left postcentral parietal area. Serial stereotactic biopsies disclosed progressive multifocal leukoencephalopathy without JC-virus in the cerebrospinal fluid. Therapy with subcutaneous interleukin-2 (IL-2) every other day and intrathecal cytarabine once a week was started. After 4 weeks the patient refused further treatment. Nevertheless her condition improved over the next 8 months and MRI scans showed a marked improvement in the lesions.