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Hans C. Lee, Victor Mulanovich, and Yago Nieto

Progressive multifocal leukoencephalopathy (PML) is a rare fatal complication of allogeneic bone marrow transplantation (BMT) resulting from chronic immunosuppression and impaired cellular immunity. This report discusses 2 cases of PML in patients with acute myeloid leukemia after allogeneic BMT. Diagnosis was made based on characteristic brain MRI findings and positive PCR results for John Cunningham virus in the cerebrospinal fluid. Unfortunately, therapeutic options are limited and nearly always result in terminal outcomes. Although immunosuppression is an unavoidable risk of allogeneic BMT, these cases highlight a rare, yet fatal, consequence of prolonged T-cell lymphopenia and impaired cellular immunity after allogeneic BMT in this patient population.

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Shaji K. Kumar, Natalie S. Callander, Kehinde Adekola, Larry D. Anderson Jr., Muhamed Baljevic, Erica Campagnaro, Jorge J. Castillo, Caitlin Costello, Christopher D’Angelo, Srinivas Devarakonda, Noura Elsedawy, Alfred Garfall, Kelly Godby, Jens Hillengass, Leona Holmberg, Myo Htut, Carol Ann Huff, Malin Hultcrantz, Yubin Kang, Sarah Larson, Hans C. Lee, Michaela Liedtke, Thomas Martin, James Omel, Aaron Rosenberg, Douglas Sborov, Jason Valent, Ryan Berardi, and Rashmi Kumar

Primary systemic light chain amyloidosis (SLCA) is characterized by production of light chains that get converted to amyloid fibrils with an affinity for visceral organs and causing organ dysfunction. The therapy for SLCA is directed to recovering the function of the affected organs by targeting the abnormal plasma cell clone and slowing deposition of amyloid fibrils. The NCCN Guidelines for SLCA provide recommendations for workup, diagnosis, and treatment of primary as well as previously treated SLCA.