Rapidly ascending necrotizing myelopathy with widespread brain white matter involvement following intrathecal methotrexate and cytosine arabinoside treatment in an adult with T cell acute lymphoblastic leukemia
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In this paper we described a case of a 53-year-old man, admitted to the hematology ward due to fatigue, dyspnea, and severe hyper-leukocytosis (WBC 356 × 109/l), diagnosed with T cell acute lymphoblastic leukemia through bone marrow (BM) aspirate. Flow cytometry showed strong positivity for CD1A, CD7, cyCD3, weak expression of CD34 and negativity for mCD3, CD4, CD8. After DNA extraction, two probes for minimal residual disease assessment (MRD) using clonal T cell receptor rearrangement were identified, both with high sensitivity (>1 × 10−4). Cerebrospinal fluid (CSF) was morphologically negative for leukemic blasts, with normal cellularity (< 1 cell/μl); however, flow cytometry demonstrated low-level positivity. Since the patient was in good performance status, induction treatment with a full pediatric protocol (AIEOP-BFM ALL 2009) was immediately started, alongside with conventional central nervous system (CNS) prophylaxis with triple intrathecal therapy (TIT, consisting...
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The authors declare that they have no conflict of interest.
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