melphalan and Encephalitis

A patient with a stage IV mantle cell lymphoma (according to the REAL classification) was treated with high-dose chemotherapy and autologous bone marrow transplantation. One year later while on alpha-interferon immunotherapy she suffered from progressive loss of short-term memory and reported difficulties in recognizing objects. Magnetic resonance imaging (MRI) showed a vast ring-enhancing lesion of the left postcentral parietal area. Serial stereotactic biopsies disclosed progressive multifocal leukoencephalopathy without JC-virus in the cerebrospinal fluid. Therapy with subcutaneous interleukin-2 (IL-2) every other day and intrathecal cytarabine once a week was started. After 4 weeks the patient refused further treatment. Nevertheless her condition improved over the next 8 months and MRI scans showed a marked improvement in the lesions.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Carmustine; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Dexamethasone; Encephalitis; Etoposide; Female; Humans; Immunoglobulins, Intravenous; Immunosuppression Therapy; Injections, Spinal; Interferon-alpha; Interleukin-12; Leukoencephalopathy, Progressive Multifocal; Lymphoma, Non-Hodgkin; Magnetic Resonance Imaging; Melphalan; Memory Disorders; Middle Aged; Podophyllotoxin; Transplantation Conditioning; Transplantation, Autologous; Vincristine