Progressive multifocal leukoencephalopathy after autologous bone marrow transplantation and alpha-interferon immunotherapy

A patient with a stage IV mantle cell lymphoma (according to the REAL class ification) was treated with high-dose chemotherapy and autologous bone marr ow transplantation. One year later while on alpha-interferon immunotherapy she suffered from progressive loss of short-term memory and reported diffic ulties in recognizing objects. Magnetic resonance imaging (MRI) showed a va st ring-enhancing lesion of the left postcentral parietal area. Serial ster eotactic biopsies disclosed progressive multifocal leukoencephalopathy with out JC-virus in the cerebrospinal fluid. Therapy with subcutaneous interleu kin-2 (IL-2) every other day and intrathecal cytarabine once a week was sta rted. After 4 weeks the patient refused further treatment. Nevertheless her condition improved over the next 8 months and MRI scans showed a marked im provement in the lesions.