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




Long-term survival in a patient with progressive multifocal leukoencephalopathy after therapy with rituximab, fludarabine and cyclophosphamide for chronic lymphocytic leukemia - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Experimental Hematology and Oncology

, 4:8

First Online: 01 March 2015Received: 12 December 2014Accepted: 09 February 2015DOI: 10.1186-s40164-015-0003-4

Cite this article as: Garrote, H., de la Fuente, A., Oña, R. et al. Exp Hematol Oncol 2015 4: 8. doi:10.1186-s40164-015-0003-4

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 severe epilepsy. The patient is alive 38 months after diagnosis of PML, which is the longest known survival to date.

KeywordsProgressive multifocal leukoencephalopathy John Cunningham virus Demyelization Immune system suppression  Download fulltext PDF



Autor: Heidys Garrote - Adolfo de la Fuente - Raquel Oña - Inmaculada Rodríguez - Juan E Echevarría - Juan M Sepúlveda - Jua

Fuente: https://link.springer.com/







Documentos relacionados