Patients with white matter lesions and multiple sclerosis (MS) may develop primary B-cell type lymphoma (PCNSL) after receiving first-line disease-modifying therapy (DMT). A recently published case report in clinical and experimental neuroimmunology showed that diffuse large B-cell lymphoma (DLBCL) from PCNSL after DMT with dimethyl fumarate (DMF) progressed rapidly in patients with relapsing and remitting MS (RRMS) and white matter lesions can.
The case study was a 56-year-old Japanese man who showed asymptomatic white matter lesions of the left frontal lobe on a medical examination on magnetic resonance imaging (MRI). At a follow-up appointment on day 46, the patient showed no neurological symptoms or brain changes on the MRI. 74 days after his initial examination, the patient had right upper extremity paralysis and was hospitalized.
Neurological symptoms improved after administration of the immunotherapy. The patient relapsed motor paralysis on day 170 and developed vision loss in the right eye. The neurological symptoms then gradually recovered without intervention. MRI on day 170 showed no white matter changes. The patient was later diagnosed with RRMS and received DMF.
3 months after receiving DMF, the patient presented with new lesions in the right basal ganglia and islet cortex. While the patient then received 2 cycles of methylprednisolone for 3 days in addition to 1 cycle of intravenous immunoglobulin for 5 days, the neurological symptoms and brain lesions progressed rapidly.
Pathological findings of the lesions of the right basal ganglia on day 301 indicated evidence of DLBCL and the patient was eventually diagnosed with B-cell-type PCNSL. He experienced partial improvement in neurological symptoms after chemotherapy so that he could walk with help. Aside from the initial white matter lesion, the brain lesions had improved by day 460 and the patient was discharged with his caregiver on day 504.
Ultimately, the study authors concluded that “patients with rapidly progressing white matter lesions after administration of DMF should be suspected of B-cell type PCNSL and diagnosed pathologically by brain biopsy.”
Kitazaki, Y., Ueno, A., Maeda, K., et al. Primary diffuse large B-cell lymphoma of the central nervous system with rapidly progressing lesions after dimethyl fumarate treatment showing relapsing and remitting symptoms: a case report. Clin Exp Neuroimmunol. Published online July 4, 2021. doi: 10.1111 / CEN3.12656
Cancer General Neurology Multiple Sclerosis Recurrent Remitting Multiple Sclerosis