Cytarabine Treatment of Progressive Multifocal Leukoencephalopathy

Cytarabine (cytosine arabinoside) was utilized in the treatment of a patient with chronic lymphocytic leukemia who developed symptomatic progressive multifocal leukoencephalopathy (PML) after a 12-year course of lymphoproliferative illness. An immediate and impressive degree of neurologic improvement occurred with the institution of antiviral chemotherapy, but clinical benefit was not sustained and the patient died of his neurologic disorder. On gross examination at postmortem, necrotic changes in the demyelinated areas of the brain were seen. Light and electron microscopic studies showed changes characteristic of PML and virus-like particles abundant in glial cells. Cytarabine may have some influence on the course of the illness, but the quality of therapeutic effect needs further investigation. (JAMA229:1313-1316, 1974)