Abstract
Natalizumab is used as a second-line treatment for multiple sclerosis (MS). Some reports have linked natalizumab to primary central nervous system lymphoma (PCNSL), although few have described its management. A 45-year-old woman with Balo’s Concentric Sclerosis presented dizziness, vertigo accompanied by dysarthria, weakness on the left side and blurred vision to the right eye after the fourth dose of natalizumab. Magnetic resonance imaging (MRI) and a brain biopsy confirmed the diagnosis of PCNSL. The patient received modified PCNSL chemotherapy (MATRix protocol) followed by high-dose chemotherapy (HDC) supported by an autologous hematopoietic stem cell transplant (ASCT) as a consolidation therapy. Thirty months later, she is still in complete remission of her PCNSL and MS. In this case, whole brain radiotherapy was excluded because it may be associated with an increased risk of neurotoxicity in MS. ASCT was preferred because it has been shown to prevent disability progression in less advanced MS stages. Our patient is the second to receive an ASCT in this context and this option of treatment should be the preferred if the patient is eligible.
Highlights
One of the main risk factors for developing primary central nervous system lymphoma (PCNSL) is immunodeficiency [1]
We report a 45-year-old female (EBV positive and human immunodeficiency virus negative) with a diagnosis of Balo’s Concentric Sclerosis (BCS) who developed a PCNSL after the fourth cycle of natalizumab
There is a probable association between natalizumab and PCNSL based on the Naranjo scale a tool that can help evaluate the probability of the adverse drug reaction [7]
Summary
One of the main risk factors for developing primary central nervous system lymphoma (PCNSL) is immunodeficiency [1]. Natalizumab is currently approved in many countries as a second-line treatment for MS. This α4-integrin binding antibody decreases lymphocyte extravasation into the central nervous system (CNS) and small intestine [3]. Of the 16 case reports published to date, only a small amount of information on management and outcomes is available [4,5]. In this case report, we discuss PCNSL diagnosis and association with natalizumab, as well as the successful management of the disease through chemotherapy and autologous stem cell transplant (ASCT)
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