Advertisement

Medical Oncology

, Volume 29, Issue 1, pp 260–262 | Cite as

Central nervous system relapse in CD56+, FLT3/ITD+ promyelocytic leukemia

  • N. Colovic
  • D. Tomin
  • A. Vidovic
  • N. Tosic
  • H. D. Atkinson
  • Milica D. Colovic
Case Report

Abstract

Central nervous system (CNS) involvement in acute promyelocytic leukemia (APL) is rare and tends to be seen mostly following treatment with all-trans retinoic acid (ATRA), due to prolonged patient survival and poor penetration of the drug in the CNS. At least 10% of extramedullary relapses in APL involve the CNS, and associated factors include an increased age, the BCR isoform, the development of differentiation syndrome, a high white cell count at presentation and hemorrhage into the CNS during induction therapy. We present the case of a patient with high-risk APL, CD56+, CD2+ in whom a CNS relapse was diagnosed through the presence of a PML/RARα rearrangement on PCR of the cerebrospinal fluid (CSF).

Keywords

Acute Promyelocytic Leukemia Bone Marrow Aspirate Idarubicin Central Nervous System Relapse Elevated White Blood Cell Count 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

This study is supported by grant No. 41004 from the Ministry of Science and the Environmental Protection of the Republic of Serbia.

References

  1. 1.
    Montesinos P, Diaz-Mediavilla J, Deben G, Prates V, et al. Central nervous system involvement at first relapse in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and anthracycline monochemotherapy without intrathecal prophylaxix. Haematologica. 2009;94(9):1242–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Bao SH, Ryoo HM, Cho HS, Lee JL, Lee KH, Hyun MS. Meningeal relapse in a patient with acute promyelocytic leukemia: a case report and reciew of the literature. J Korean Med Sci. 2004;19:311–4.CrossRefGoogle Scholar
  3. 3.
    Čolović N, Bogdanović A, Miljić P, Janković G, Čolović M. Central nervous system relapse in acute promyelocytic leukemia. Am J Hematol. 2002;71:60–1.PubMedCrossRefGoogle Scholar
  4. 4.
    Nagai S, Asai T, Watanabe T, Oshima K, Hangaishi A, Kanda Y, et al. Simultaneous appearance of central nervous system relapse and subarachnoidal hemorrhage during the treatment for acute promyelocytic leukemia. Ann Hematol. 2008;87(7):593–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Saiki I, Fujii H, Yoneda J, Abe F, Nakajima M, Tsuruo T, Azuma I. Role of aminopeptidase N (CD13) in tumor-cell invasion and extracellular matrix degradation. Int J Cancer. 1993;54:137–43.PubMedCrossRefGoogle Scholar
  6. 6.
    Sanz MA, Martin G, Gonzalez M, et al. Risk-adapted treatment of acute promyelocytic leukemia with all-transretinoic acid and anthracycline monochemotherapy: a multicenter study by the PETHEMA group. Blood. 2004;103:1237–43.PubMedCrossRefGoogle Scholar
  7. 7.
    Lengfelder E, Reichert A, Schoch C, et al. Double induction strategy including high dose cytarabine in combination with all-trans retinoic acid: effects in patients with newly diagnosed acute promyelocytic leukemia. German AML Cooperative Group. Leukemia. 2000;14:1362–70.PubMedCrossRefGoogle Scholar
  8. 8.
    Murray KC, Estey E, Paietta E, Howard RS, Edenfield JW, Pierce Sh, Mann KP, Bolan Ch, Byrd JC. CD56 expression in acute promyelocytic leukemia:a possible indicator of poor treatment outcome? JCO. 1999;17:293–7.Google Scholar
  9. 9.
    Čolović N, Čolović M, Čemerikić V, Terzić T, Ivanović S, Skender M, Bošković D. Granulocytic sarcoma of the brain in a patient with acute myeloid leukemia. ACI. 2004;L1:129–31. br 3.Google Scholar
  10. 10.
    Breccia M, Carmosino I, Diverio D, De Santis S, De Propris MS, Romano A, et al. Early detection of meningeal localization in acute promyelocytic leukemia patients with high presenting leukocyte count. Br J Haematol. 2003;120(2):266–70.PubMedCrossRefGoogle Scholar
  11. 11.
    Nagai S, Nannya Y, Arai S, Yoshiki Y, Takahashi T, Kurokawa M. Molecular and cytogenetic monitoring and preemptive therapy for central nervous system relapse of acute promyelocytic leukemia. Haematologica. 2010;95:169–71.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • N. Colovic
    • 1
    • 2
  • D. Tomin
    • 1
    • 2
  • A. Vidovic
    • 1
    • 2
  • N. Tosic
    • 3
  • H. D. Atkinson
    • 4
  • Milica D. Colovic
    • 1
  1. 1.Institute of Hematology, Clinical Center for SerbiaBelgradeSerbia
  2. 2.Medical FacultyUniversity of Belgrade School of MedicineBelgradeSerbia
  3. 3.Laboratory for Molecular HematologyInstitute of Molecular Genetics and Genetic EngineeringBelgradeSerbia
  4. 4.North Middlesex University HospitalLondonUK

Personalised recommendations