Abstract
This open label study determined the outcome of non-AIDS progressive multifocal leukoencephalopathy patients treated with a standard dose of intravenous cytosine arabinoside. Nineteen patients with PML proven by brain biopsy or spinal fluid polymerase chain reaction were treated with intravenous cytosine arabinoside 2 mg/kg per day for 5 days and followed for neurologic outcome by neurologic examination and MRI scanning. Seven of 19 PML patients treated with cytosine arabinoside intravenously improved neurologically. The range of follow-up for these patients was 2.0 to 4.5 years. All were left with neurologic deficits but were functionally improved, and 6 of 7 were able to independently carry out the activities of daily living. Twelve PML patients showed no evidence of response and died rapidly of their disease after treatment (range, 8 days to 6 months). All who survived their neurologic disease recovered from treatment-induced pancytopenia. Cytosine arabinoside given intravenously to non-AIDS PML patients in this small study was associated with a 36% chance of developing stabilization at 1 year. Treatment was associated with significant bone marrow toxicity. The improvement in MRI scan changes in those patients who responded took 6 weeks or longer.
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Aksamit AJ Jr (1993). Nonradioactive in situ hybridization in progressive multifocal leukoencephalopathy. Mayo Clin Proc 68(9): 899–910.
Bauer WR, Turel AP Jr, Johnson KP (1973). Progressive multifocal leukoencephalopathy and cytarabine. Remission with treatment. JAMA 226(2): 174–176.
Berger JR, Mucke L (1988). Prolonged survival and partial recovery in AIDS-associated progressive multifocal leukoencephalopathy. Neurology 38(7): 1060–1065.
Brooks BR, Walker DL (1984). Progressive multifocal leukoencephalopathy. Neurol Clin 2(2): 299–313.
Clifford DB, Yiannoutsos C, Glicksman M, Simpson DM, Singer EJ, Piliero PJ, Marra CM, Francis GS, McArthur JC, Tyler KL, Tselis AC, Hyslop NE (1993). HAART improves prognosis in HIV-associated progressive multifocal leukoencephalopathy. Neurology 52(3): 623–625.
Hall CD, Dafni U, Simpson D, Clifford D, Wetherill PE, Cohen B, McArthur J, Hollander H, Yainnoutsos C, Major E, Millar L, Timpone J (1998). Failure of cytarabine in progressive multifocal leukoencephalopathy associated with human immunodeficiency virus infection. AIDS Clinical Trials Group 243 Team. N Engl J Med 338(19): 1345–1351.
Kepes JJ, Chou SM, Price LW Jr (1975). Progressive multifocal leukoencephalopathy with 10-year survival in a patient with nontropical sprue. Report of a case with unusual light and electronmicroscopic features. Neurology 25(11): 1006–1012.
Lidman C, Lindqvist L, Mathiesen T, Grane P (1991). Progressive multifocal leukoencephalopathy in AIDS. AIDS 5(8): 1039–1041.
Marriott PJ, O’Brien MD, Mackenzie IC, Janota I (1975). Progressive multifocal leucoencephalopathy: remission with cytarabine. J Neurol Neurosurg Psychiatry 38(3): 205–209.
Nicoli F, Chave B, Peragut JC, Gastaut JL (1992). Efficacy of cytarabine in progressive multifocal leucoencephalopathy in AIDS. Lancet 339(8788): 306.
O’Riordan T, Daly PA, Hutchinson M, Shattock AG, Gardner SD (1990). Progressive multifocal leukoencephalopathy-remission with cytarabine. J Infect 20(1): 51–54.
Peters AC, Versteeg J, Bots GT, Boogerd W, Vielvoye GJ (1980). Progressive multifocal leukoencephalopathy: immunofluorescent demonstration of simian virus 40 antigen in CSF cells and response to cytarabine therapy. Arch Neurol 37(8): 497–501.
Portegies P, Algra PR, Hollak CE, Prins JM, Reiss P, Valk J, Lange JM (1991). Response to cytarabine in progressive multifocal leucoencephalopathy in AIDS. Lancet 337(8742): 680–681.
Price RW, Nielsen S, Horten B, Rubino M, Padgett B, Walker D (1983). Progressive multifocal leukoencephalopathy: a burnt-out case. Ann Neurol 13(5): 485–490.
Rockwell D, Ruben FL, Winkelstein A, Mendelow H (1976). Absence of immune deficiencies in a case of progressive multifocal leukoencephalopathy. Am J Med 61(3): 433–436.
Saxton C, Gailiunas P Jr, Helderman JH, Farkas RA, McCoy R, Diehl J, Sagalowsky A, Murphy FK, Ross ED, Silva FR (1984). Progressive multifocal leukoencephalopathy in a renal transplant recipient. Increased diagnostic sensitivity of computed tomographic scanning by double-dose contrast with delayed films. Am J Med 77(2): 333–337.
Schlitt M, Morawetz RB, Bonnin J, Chandra-Sekar B, Curtiss JJ, Diethelm AG Jr, Whelchel JD, Whitley RJ (1986). Progressive multifocal leukoencephalopathy: three patients diagnosed by brain biopsy, with prolonged survival in two. Neurosurgery 18(4): 407–414.
Steiger MJ, Tarnesby G, Gabe S, McLaughlin J, Schapira AH (1993). Successful outcome of progressive multifocal leukoencephalopathy with cytarabine and interferon. Ann Neurol 33(4): 407–411.
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Aksamit, A.J. Treatment of non-AIDS progressive multifocal leukoencephalopathy with cytosine arabinoside. Journal of NeuroVirology 7, 386–390 (2001). https://doi.org/10.1080/13550280152537292
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DOI: https://doi.org/10.1080/13550280152537292