Progressive multifocal leukoencephalopathy after allogeneic bone marrow transplantation for acute myeloid leukemia

Area of Science:

• Neurology
• Hematology
• Infectious Diseases

Background:

• Progressive multifocal leukoencephalopathy (PML) is a rare but fatal neurological complication.
• It arises from John Cunningham virus (JCV) reactivation in immunocompromised individuals.
• Allogeneic bone marrow transplantation (BMT) involves significant immunosuppression, increasing PML risk.

Purpose of the Study:

• To report two cases of PML in patients with acute myeloid leukemia (AML) post-allogeneic BMT.
• To highlight the diagnostic methods and clinical course of PML in this specific patient group.
• To underscore the challenges in managing PML following BMT.

Main Methods:

• Case report of two patients diagnosed with PML after allogeneic BMT for AML.
• Diagnosis confirmed by characteristic brain Magnetic Resonance Imaging (MRI) findings.
• Detection of John Cunningham virus (JCV) DNA in cerebrospinal fluid (CSF) via Polymerase Chain Reaction (PCR).

Main Results:

• Both patients presented with neurological deficits indicative of PML.
• Brain MRI revealed characteristic demyelinating lesions.
• Cerebrospinal fluid PCR confirmed the presence of JCV DNA.
• Therapeutic interventions were limited, and outcomes were fatal.

Conclusions:

• PML is a rare, life-threatening complication of allogeneic BMT, particularly in AML patients.
• Prolonged T-cell lymphopenia and impaired cellular immunity post-BMT are key risk factors.
• Early diagnosis through MRI and JCV PCR is crucial, despite limited treatment efficacy.