Progressive multifocal leukoencephalopathy: a report of three cases in HIV-negative patients with non-Hodgkin's lymphomas treated with rituximab

摘要: Case 1 A 45-year-old male patient with mantle cell lymphoma was treated four courses of R-hyperCVAD (October 2000–August 2001), followed by mitoxantrone and melphalan supported autologous hematopoietic stem transplantation (HSCT; October 2001). Complete remission maintained rituximab 375 mg/m (May–June 2002). On November 2005, a bone relapse required R-DHAP (ended in February 2006) BEAM-conditioned allogeneic HSCT (March 2006). Graft-versus-host disease prophylaxis carried out methotrexate 15 on day +1 10 days +3, +6, +11, cyclosporine titrated to keep serum levels between 200 400 pg/ml until 2006. Five maintenance (375 mg/m) were then administered (January 2007–April 2008). April 2008, while complete remission, he developed bilateral hemianopsia. Magnetic resonance imaging (MRI) displayed subcortical lesions the white matter. stereotactic brain biopsy (June 2008) revealed presence JCV DNA polymerase chain reaction (PCR), histomorphology confirmed PML. Despite treatments mirtazapine 30–45 mg/day orally, cidofovir 5 mg/kg intravenously (four courses), risperidone 4 mg/bid follow-up MRIs (June–September showed progression