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Central nervous system graft-versus-host disease: consider progressive multifocal leukoencephalopathy among the differential diagnoses

Bone Marrow Transplantation volume 40, pages 1095–1096 (2007)Cite this article

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Kamble et al.1 recently provided a review of cases of central nervous system graft-versus-host disease (CNS GVHD). The authors conclude that ‘when relapse of a CNS neoplastic process, opportunistic infections as well as EBV related post-transplant lymphoproliferative disorders (PTLD) among other diagnoses are all excluded by means of thorough studies, the possibility of CNS-GVHD may be entertained'. We discuss here the basis for the requirements to rule out another fatal but potentially curable CNS disease, namely progressive multifocal leukoencephalopathy (PML).

Both original cases reported by Kamble et al. had hyperintense white matter lesions (WMLs) on T2-weighted images at magnetic resonance imaging, a finding that in allogeneic hematopoietic stem cell transplant recipients should have encouraged investigations for PML, especially if they had been previously treated with fludarabine2 (as for case 2) or rituximab.3 According to consensus terminology,4 these patients actually fulfilled the criteria for possible PML. Similarly, 7 of the 10 cases reported in Table 1 had focal or diffuse WML at magnetic resonance imaging.

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Authors and Affiliations

  1. Department of Oncology, Division of Hematology, Transplantation and Advanced Medicine, Azienda Ospedaliera Universitaria Santa Chiara, Pisa, Italy

    D Focosi, S Galimberti, F Papineschi & M Petrini

  2. Department of Psychiatry, University of Vermont, Burlington, VT, USA

    R E Kast

  3. Division of Virology, Azienda Ospedaliera Santa Chiara, University of Pisa, Pisa, Italy

    F Maggi & L Ceccherini-Nelli

Authors
  1. D Focosi
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  2. R E Kast
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  3. F Maggi
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  4. S Galimberti
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  5. F Papineschi
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  6. M Petrini
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  7. L Ceccherini-Nelli
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Correspondence to D Focosi.

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Focosi, D., Kast, R., Maggi, F. et al. Central nervous system graft-versus-host disease: consider progressive multifocal leukoencephalopathy among the differential diagnoses. Bone Marrow Transplant 40, 1095–1096 (2007). https://doi.org/10.1038/sj.bmt.1705874

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