J Korean Med Sci.  2010 Apr;25(4):630-633. 10.3346/jkms.2010.25.4.630.

Cytomegalovirus Ventriculoencephalitis after Unrelated Double Cord Blood Stem Cell Transplantation with an Alemtuzumab-containing Preparative Regimen for Philadelphia-positive Acute Lymphoblastic Leukemia

• Lee S
• Kim SH
• Choi SM
• Lee DG
• Kim SY
• Lee JW
• Min WS
• Shin WS
• Kim CC

• KMID: 1792937
• DOI: http://doi.org/10.3346/jkms.2010.25.4.630

Abstract

Despite the prophylaxis and preemptive strategies using potent antiviral agents, cytomegalovirus (CMV) remains a major infectious cause of morbidity and mortality in allogeneic stem cell transplantation (SCT) recipients. Delayed immune reconstitution after SCT, such as cord blood and T-cell depleted SCT with the use of alemtuzumab, has been associated with an increased frequency of CMV disease as well as CMV reactivation. CMV disease involving central nervous system is an unusual presentation in the setting of SCT. We report a case of CMV ventriculoencephalitis after unrelated double cord blood SCT with an alemtuzumab-containing preparative regimen for Philadelphia-positive acute lymphoblastic leukemia.

Keyword

Alemtuzumab; Cord Blood Stem Cell Transplantation; Cytomegalovirus; Encephalitis; Leukemia

MeSH Terms

Antibodies, Monoclonal/pharmacology/*therapeutic use
Antibodies, Monoclonal, Humanized
Antibodies, Neoplasm/pharmacology/*therapeutic use
Antineoplastic Agents/pharmacology/*therapeutic use
Cord Blood Stem Cell Transplantation/*adverse effects
Cytomegalovirus/drug effects
Cytomegalovirus Infections/*drug therapy/*etiology/physiopathology
*Encephalitis/etiology/pathology/virology
Fatal Outcome
Humans
Male
*Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications/drug therapy/virology
Transplantation Conditioning/methods
Antibodies, Monoclonal
Antibodies, Monoclonal, Humanized
Antibodies, Neoplasm
Antineoplastic Agents

Figure

• 

  Fig. 1 Brain magnetic resonance images. The T1-weighted image (A) showed periventricular enhancement of subependymal regions (▼), which indicated the ventriculoencephalitis. The FLAIR image (B) showed hyperintense lesions (*) in the hippocampus bilaterally, which can be seen in diffuse encephalitis.

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  Fig. 2 Gel electrophoresis of DNA fragments amplified by multiplex PCR. DNA was extracted using a QIAamp DNA Mini Kit (QIAGEN, Germany). Then, the PCR for CMV and HHV-6, described previously by Park et al. (18), was performed as positive control. Template DNAs for the different viruses were isolated from each CMV AD169 (ATCC VR-538) and HHV6-B (HST strain, provided by K Tanaka-Taya, Osaka University Graduate School of Medicine, Osaka, Japan). Lanes: M, 100 bp DNA ladder; 1, negative control; 2, CMV; 3, HHV-6; 4, CSF of the patient.

• 

  Fig. 3 The clinical course and RQ-PCR data. *Cut-off value for pre-emptive therapy of CMV DNAemia in cord blood transplantation recipients as part of high-risk group at our center.

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