title: Progressive multifocal leukoencephalopathy with detection of JC virus in a patient with chronic lymphocytic leukemia parallel to onset of fludarabine therapy.
abstract: Along with the establishment of more intense chemotherapeutic regimens including fludarabine for the treatment of indolent lymphoproliferative diseases like chronic lymphocytic leukemia (CLL), an increasing amount of cases with progressive multifocal leukoencephalopathy (PML) due to JC virus have been observed. We report a patient with CLL who developed PML parallel to the onset of fludarabine therapy. Spinal fluid was tested positive for JC virus. Despite virostatic treatment with cidofovir, neurologic symptoms were progressive and the disease ultimately fatal. The present case suggests that immunosuppression caused by chronic lymphoproliferative malignancies alone may be a factor in the development of PML. Chemotherapy with fludarabine may act as an additional trigger. The question remains whether serologic screening for JC virus in patients with chronic lymphoproliferative disease undergoing intense chemotherapy might be valuable once sufficient antiviral treatment has been established.
authors.affiliation: Department of Hematology, Oncology and Transfusion Medicine, Benjamin Franklin University Hospital, Free University of Berlin, Berlin, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kiewe
authors.forename: Sepp
authors.initials: S
authors.lastname: Seyfert
authors.forename: Sixten
authors.initials: S
authors.lastname: Körper
authors.forename: Kathrin
authors.initials: K
authors.lastname: Rieger
authors.forename: Eckhard
authors.initials: E
authors.lastname: Thiel
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Knauf
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000235:genetics; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D007165:Immunosuppression Therapy; D007577:JC Virus / Q000235:genetics / Q000302:isolation & purification*; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000175:diagnosis / Q000821:virology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D004279:DNA, Viral; D014740:Vidarabine; C024352:fludarabine