Long-term survival in a patient with progressive multifocal leukoencephalopathy after therapy with rituximab, fludarabine and cyclophosphamide for chronic lymphocytic leukemia

Experimental Hematology & Oncology
Heidys GarroteJuan F García

Abstract

A 50-year-old male with chronic lymphocytic leukemia (CLL) was treated with fludarabine, cyclophosphamide and rituximab, which produced a complete remission. Eight months after the last dose of rituximab he had visual disturbance, diminished muscular strength in the right arm and vesicular-papular lesions in the left ophthalmic branch region of the V cranial nerve. These were initially interpreted as herpes virus encephalopathy (HVE), but brain magnetic resonance imaging (MRI) showed evidence of demyelination consistent with progressive multifocal leukoencephalopathy (PML). Cerebrospinal fluid (CSF) analysis was negative for varicella zoster virus (VZV) and John Cunningham virus (JCV) DNA. The clinical suggestion of PML prompted us to perform a brain biopsy and to start treatment with mefloquine. In the brain biopsy, histopathological features of demyelination were described and the polymerase chain reaction (PCR) identified JCV, confirming the diagnosis of PML. Treatment with mefloquine (250 mg/week) and dexamethasone (4 mg/day) was started and maintained for 6 months. A year later there was an almost complete resolution of the MRI lesions and the patient achieved a stable clinical state with persisting motor impairment and se...Continue Reading

References

Mar 5, 2009·Antimicrobial Agents and Chemotherapy·Margot BrickelmaierLeonid Gorelik
Jan 15, 2014·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Martin D BergerGeorg Stussi
Jul 6, 2014·British Journal of Haematology·David R BruceAnna Schuh

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Citations

Jun 9, 2016·Expert Review of Neurotherapeutics·Jean-Michel VallatStéphane Mathis
Dec 23, 2015·American Journal of Hematology·Kanti R Rai, Preetesh Jain
Apr 20, 2018·Cancer Imaging : the Official Publication of the International Cancer Imaging Society·Babina GosangiKatherine Krajewski

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Methods Mentioned

BETA
PCR
biopsy

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