Progressive Multifocal Leukoencephalopathy after Administration of Front-Line Obinutuzumab and Venetoclax in a Patient with Chronic Lymphocytic Leukemia: Case Report
Bibliographic record
Abstract
Introduction: Progressive multifocal leukoencephalopathy (PML) is a rare and often fatal demyelinating disease of the central nervous system caused by the reactivation of the John Cunningham virus (JCV) in immunocompromised patients. Obinutuzumab is type II anti-CD 20 antibody, used in combination with venetoclax for chronic lymphocytic leukemia (CLL). Case Presentation: A 75-year-old female patient was diagnosed with PML after a short course of obinutuzumab and venetoclax started for a newly diagnosed CLL. There was no history of hepatitis B, C, or human-immunodeficiency virus. Quantitative immunoglobulin levels were normal. She completed four infusions of obinutuzumab and subsequently started venetoclax, ramping up dose. Five days after the last dose of obinutuzumab, she developed forgetfulness and irrational behavior. Simultaneously, she had a new onset of cough and dyspnea and was subsequently diagnosed with a COVID-19 infection. One week later, her neurological condition began to deteriorate. Neurological examination did not reveal any focal neurological deficits. Magnetic resonance imaging head showed a nonspecific white matter signal change extensively involving the left frontal lobe, crossing the corpus callosum into the deep white matter of the right frontal lobe. Analysis of the cerebrospinal fluid was positive for the JCV, leading to a diagnosis of PML. Following a single dose of intravenous immunoglobulin 0.4 g/kg, the patient had a transient improvement of symptoms but subsequently deteriorated and died 1 month later. Conclusion: PML is a rare complication of anti-CD 20 monoclonal antibodies, including obinutuzumab. Early recognition of PML is essential to discontinue an affecting drug and initiate therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".