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Table 2 Clinicopathological findings of two cases with autopsy-proven chemobrains

From: Toxic leukoencephalopathy with axonal spheroids caused by chemotherapeutic drugs other than methotrexate

 

Case 1

Case 2

Age/Gender

64/F

63/M

Active problem

Loss of consciousness, sleep tendency, type I respiratory failure due to aspiration pneumonia and sepsis

Disorientation, drowsy mentality, sleep tendency, coma

Pneumonia, sepsis, & DIC, multiorgan failure

Underlying disease

Relapsed Acute undifferentiated myelogenous leukemia

Myelodysplastic syndrome excess blast 1 (MDS-EB1)

Chemotherapy-Regimen

FLAG, IDAC

Azacitidine #3

Transplant

MUD-alloPBSCT

MUD-alloPBSCT

Autopsy finding

Numerous axonal spheroid with vacuolar changes of the white matter and exogenous foamy macrophage (CD68-positive/TMEM119-negative) infiltration

Beta-amyloid deposit in the degenerated axons of the optic tract of occipital and temporal lobes

Numerous axonal spheroids with vacuolation of the white matter with exogenous foamy macrophage (CD68-positive/TMEM119-negative) infiltration

Beta-amyloid deposit in the axons, extensively in the most white matter

Main involving area

The white matter of the occipital and temporal lobe

The white matter of the occipital, temporal, and parietal lobe

T- or B-lymphocytes

Absent in the entire brain parenchyma

Absent in the entire brain parenchyma

Survival

3 months after alloPBSCT

4 months after alloPBSCT (about 3 months after onset of disorientation)

  1. FLAG (fludarabine, Ara-Cytarabine, granulocyte colony-stimulating factor), IDAC Intermediate-dose Ara-Cytarabine, MUD Matched unrelated donor, allPBSCT Allogeneic peripheral blood stem cell transplantation