TY - JOUR
T1 - Concurrent progressive multifocal leukoencephalopathy and central nervous system infiltration by multiple myeloma
T2 - A case report
AU - Ruiz-Heredia, Yanira
AU - Sanchez-Vega, Beatriz
AU - Barrio, Santiago
AU - Linares, María
AU - Rapado, Inmaculada
AU - Braggio, Esteban
AU - Stewart, Keith
AU - Folgueira, M. Dolores
AU - Ramos, Ana
AU - Collado, Luis
AU - Ruiz, Juan
AU - Toldos, Oscar
AU - Hernandez-Lain, Aurelio
AU - Martinez-Lopez, Joaquin
N1 - Publisher Copyright:
© The Author(s) 2018.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Progressive multifocal leukoencephalopathy rarely occurs in patients with multiple myeloma. Intracranial central nervous system invasion is also an uncommon event in multiple myeloma, occurring in less than 1% of cases. We describe herein an exceptional case of coexisting progressive multifocal leukoencephalopathy and intraparenchymal central nervous system myeloma infiltration. A 73-year-old woman with relapsed multiple myeloma was treated with 15 cycles of lenalidomide and dexamethasone, but therapy had to be stopped because of a hip fracture after a fall. During hospitalization, the patient developed progressive multifocal leukoencephalopathy caused by John Cunningham virus, and a prominent intra-parenchymal CD138-positive infiltrate was detected. VDJ rearrangements of the immunoglobulin heavy chain gene and the mutational profile of plasma cells in bone marrow at the time of diagnosis and in brain biopsy after progression were analyzed by next generation sequencing, showing genetic differences between medullary and extramedullary myeloma cells. The role of long-term treatment with lenalidomide and dexamethasone in the development progressive multifocal leukoencephalopathy or intraparenchymal central nervous system myeloma infiltration remains unknown. However, our results suggest that both events may have arisen as a consequence of treatment-related immunosuppression. Thus, an appropriate clinical approach compatible with the simultaneous treatment of progressive multifocal leukoencephalopathy and multiple myeloma should be developed.
AB - Progressive multifocal leukoencephalopathy rarely occurs in patients with multiple myeloma. Intracranial central nervous system invasion is also an uncommon event in multiple myeloma, occurring in less than 1% of cases. We describe herein an exceptional case of coexisting progressive multifocal leukoencephalopathy and intraparenchymal central nervous system myeloma infiltration. A 73-year-old woman with relapsed multiple myeloma was treated with 15 cycles of lenalidomide and dexamethasone, but therapy had to be stopped because of a hip fracture after a fall. During hospitalization, the patient developed progressive multifocal leukoencephalopathy caused by John Cunningham virus, and a prominent intra-parenchymal CD138-positive infiltrate was detected. VDJ rearrangements of the immunoglobulin heavy chain gene and the mutational profile of plasma cells in bone marrow at the time of diagnosis and in brain biopsy after progression were analyzed by next generation sequencing, showing genetic differences between medullary and extramedullary myeloma cells. The role of long-term treatment with lenalidomide and dexamethasone in the development progressive multifocal leukoencephalopathy or intraparenchymal central nervous system myeloma infiltration remains unknown. However, our results suggest that both events may have arisen as a consequence of treatment-related immunosuppression. Thus, an appropriate clinical approach compatible with the simultaneous treatment of progressive multifocal leukoencephalopathy and multiple myeloma should be developed.
KW - John Cunningham virus
KW - Progressive multifocal leukoencephalopathy
KW - central nervous system myeloma infiltration
KW - inmunomodulator side effect
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U2 - 10.1177/1078155218769367
DO - 10.1177/1078155218769367
M3 - Article
C2 - 29690814
AN - SCOPUS:85064349019
SN - 1078-1552
VL - 25
SP - 998
EP - 1002
JO - Journal of Oncology Pharmacy Practice
JF - Journal of Oncology Pharmacy Practice
IS - 4
ER -