Central nervous system relapse in CD56+, FLT3/ITD+ promyelocytic leukemia
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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).
KeywordsAcute Promyelocytic Leukemia Bone Marrow Aspirate Idarubicin Central Nervous System Relapse Elevated White Blood Cell Count
This study is supported by grant No. 41004 from the Ministry of Science and the Environmental Protection of the Republic of Serbia.
- 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
- 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.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.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