Progressive multifocal leukoencephalopathy after autologous peripheral blood stem cell transplantation in a patient with multiple myeloma treated with combination therapy

Yokokawa, Kazuki; Hisahara, Shin; Matsuura, Yuichi; Ikeda, Kazuna; Tsuda, Etsuko; Saitoh, Masaki; Nakamichi, Kazuo; Saijo, Masayuki; Kamihara, Yusuke; Sato, Tsutomu; Kawamata, Jun; Shimohama, Shun

doi:10.1016/j.jns.2016.07.045

Cited by 14 publications

(11 citation statements)

References 8 publications

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“…The majority of cases of leukoencephalopathy in patients with MG are secondary to treatment and/or immunodeficiency. For instance, caused by JC virus infection (progressive multifocal leukoencephalopathy), or due to posterior reversible encephalopathy syndrome (PRES) . Our patient was treatment naïve, which suggests an association with the disease itself instead of a complication of treatment.…”

Section: Discussionmentioning

confidence: 73%

Smoldering Multiple Myeloma Associated Leukoencephalopathy Presenting with Holmes Tremor, Ataxia, and Pyramidal Syndrome

Aquino

Connolly

Lang

2018

Movement Disord Clin Pract

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Section: Discussionmentioning

confidence: 73%

Smoldering Multiple Myeloma Associated Leukoencephalopathy Presenting with Holmes Tremor, Ataxia, and Pyramidal Syndrome

Aquino

Connolly

Lang

2018

Movement Disord Clin Pract

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“…Repeated MRI demonstrated no further progression of the previously found lesions. One year after disease onset, this patient was still alive 23…”

Section: Discussionmentioning

confidence: 90%

Progressive multifocal leukoencephalopathy following five lines of therapy and three autologous bone marrow transplants for multiple myeloma

et al. 2020

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A 59-year-old man, with a background of multiply relapsed myeloma, presented with a 3-week history of confusion, short-term memory impairment and behavioural changes. CT head showed bilateral white matter changes and numerous, large lytic lesions of the skull vault. MRI brain revealed multiple areas of hyperintensity on T2-weighted sequences which did not enhance (many of which showed diffusion restriction) unexpectedly bringing progressive multifocal leukoencephalopathy (PML) into the differential. Initial cerebrospinal fluid studies were largely unremarkable, aside from a mildly elevated protein; cultures were negative. PCR for the John Cunningham (JC) virus was positive. Considering the patient’s medical history and rapidily progressive symptoms, a palliative approach was adopted, with the patient dying 14 days later. We present this case as an example of PML in a patient with multiple myeloma, highlighting the need to consider this diagnosis in an enlarging population of heavily treated, severely immunocompromised, patients.

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“…No previous cases of pml in the setting of ixazomib have been reported, but cases of pml have been documented after treatment with a related proteosome inhibitor, bortezomib 8,9 . In 2008, Kesari et al reported on a woman with acute myelogenous leukemia (aml) who presented with dysarthria and left facial weakness two years following a course of treatment with bortezomib, idarubicin, and cytarabine 8 .…”

Section: Figurementioning

confidence: 99%

“…She made a dramatic recovery, remaining stable for another 28 months until she died from progression of the aml. In 2016, Yokokawa et al reported a 62-year-old man with a history of multiple myeloma who presented with gait disturbance and speech difficulty one year after receiving a course of bortezomib and dexamethasone therapy 9 . He was diagnosed with pml and treated with mirtazapine and mefloquine.…”

Section: Figurementioning

confidence: 99%

“…Signs and symptoms may include motor weakness, visual field defects, gait abnormalities, and language problems 4 , but the specific neurological deficits depend on which brain regions are affected. Cases of pml have been documented in patients with hematological malignancies, including multiple myeloma and acute myelogenous leukemia, treated with chemotherapeutic agents [5][6][7][8][9] . Here we describe a case of pml in a patient with multiple myeloma treated with ixazomib, a novel proteosome inhibitor 10 .…”

Section: Introductionmentioning

confidence: 99%

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Progressive Multifocal Leukoencephalopathy during Ixazomib-Based Chemotherapy

et al. 2018

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Progressive multifocal leukoencephalopathy (pml) is a rare demyelinating disease of the central nervous system that most often affects immunocompromised individuals. It is caused by the reactivation of the John Cunningham virus (jcv), which is found in latent form in the majority of adults. We describe a 59-year-old man with multiple myeloma who developed severe neurological deficits during treatment with ixazomib-based chemotherapy. A diagnosis of pml was established with gadolinium-enhanced magnetic resonance imaging (mri) and by detection of jcv in the cerebrospinal fluid. Despite cessation of chemotherapy and treatment with mirtazapine, he had an inexorable neurological decline and died two months after presenting to hospital. Multiple myeloma and its treatments can predispose patients to opportunistic infections including pml. Although there have been case reports of pml in patients with multiple myeloma treated with bortezomib (a different proteosome inhibitor), this is, to our knowledge, the first documented case of pml in a patient treated with a regimen that includes ixazomib.

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Progressive multifocal leukoencephalopathy after autologous peripheral blood stem cell transplantation in a patient with multiple myeloma treated with combination therapy

Cited by 14 publications

References 8 publications

Smoldering Multiple Myeloma Associated Leukoencephalopathy Presenting with Holmes Tremor, Ataxia, and Pyramidal Syndrome

Smoldering Multiple Myeloma Associated Leukoencephalopathy Presenting with Holmes Tremor, Ataxia, and Pyramidal Syndrome

Progressive multifocal leukoencephalopathy following five lines of therapy and three autologous bone marrow transplants for multiple myeloma

Progressive Multifocal Leukoencephalopathy during Ixazomib-Based Chemotherapy

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