Saumoy Maria, Castells Gerard, Escoda Lourdes, Marés Rafel, Richart Cristobal, Ugarriza Aranzazu
Servei d'Hematologia, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain.
Leuk Lymphoma. 2002 Feb;43(2):433-6. doi: 10.1080/10428190290006297.
A 65-year-old man with chronic lymphocytic leukemia (CLL) diagnosed 11 years ago and treated with standard dose of fludarabine developed a rapidly fatal progressive neurological syndrome. Differential diagnoses included brain infiltration by CLL as opposed to progressive multifocal leukoencephalopathy (PML). A magnetic resonance imaging (MRI) scan showed a hyperintense T2-weighted signal in the left frontal region. Cerebro-spinal fluid polymerase chain reaction (PCR) was positive for virus JC (JCV). These findings were compatible with the diagnosis of PML. Fludarabine has been used to treat acute leukemias, CLL and follicular lymphomas. Its toxicity includes myelosuppression, immunosuppression and sporadic life-threatening neurotoxicity, although standard doses of it are considered safe. Late-onset fatal cerebral dysfunction caused by JCV after standard-dose fludarabine has been described previously. The widespread and increasing use of fludarabine makes it interesting to define the potential of standard doses of fludarabine for causing severe neurological side-effects such as PML.
一名65岁男性，11年前被诊断为慢性淋巴细胞白血病（CLL），接受标准剂量氟达拉滨治疗，之后出现了一种迅速致命的进行性神经综合征。鉴别诊断包括CLL脑浸润与进行性多灶性白质脑病（PML）。磁共振成像（MRI）扫描显示左侧额叶区域T2加权信号呈高信号。脑脊液聚合酶链反应（PCR）检测显示JC病毒（JCV）呈阳性。这些发现符合PML的诊断。氟达拉滨已被用于治疗急性白血病、CLL和滤泡性淋巴瘤。其毒性包括骨髓抑制、免疫抑制和偶发的危及生命的神经毒性，尽管标准剂量的氟达拉滨被认为是安全的。此前已有关于标准剂量氟达拉滨后由JCV引起迟发性致命性脑功能障碍的描述。氟达拉滨的广泛且日益增加的使用使得确定标准剂量氟达拉滨导致如PML等严重神经副作用的可能性变得很有意义。
