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Central nervous system blast crisis of chronic myeloid leukemia and treatment with dasatinib
( Hong Suk Park ),( Jinny Park ),( Young Saeng Kim ),( In Geun Park ),( Jun Sik Hong ),( Hee Kyong Ahn ),( Sun Jin Sim ),( Eun Kyoung Joe ),( Dong Bok Shin ),( Jae Hoon Lee ) 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1
Chronic myeloid leukemia (CML) is a myeloproliferative disorder driven by the BCR-ABL1. Owing to the high efficacy of imatinib mesylate for CML in chronic phase, the frequency of the blast crisis is greatly reduced. Some CML cases develop extramedullary disease caused by infiltration of blast cells. However, the central nervous system (CNS) as an isolated site of extramedullary blast crisis is rare. Herein, we report case of dasatinib-based maintenance therapy for lymphoid blast crisis of the CNS in a patient with CML who was receiving imatinib mesylate therapy. In July 2012, a 55 years old man was diagnosed with Philadelphia chromosome positive CML in the chronic phase. Immediately, imatinib mesylate administration was initiated. Four months after the diagnosis, he complained of headache. On cerebrospinal fluid (CSF) examination, the CSF had increased number of WBCs (6289/iL); almost all WBCs were lymphoid cells. Brain MRI revealed abnormal leptomeningeal enhancement of the frontal lobes. In addition to a complete hematological, cytogenetic response and evidence of the absence of malignant lymphoblasts in the peripheral blood and bone marrow samples, these findings led to the diagnosis of isolated lymphoid blast crisis in CNS. Immediately, the patient was treated with scheduled intrathecal methotrexate, cerebrospinal radiotherapy and TKI dasatinib. Major molecular response was achieved after 4 months after treatment change, followed by matched related allogeneic peripheral blood SCT. During the course of dasatinib maintenance therapy, several follow-up tests were performed and persistently yielded results indicating complete hematologic, molecular, and cytogenetic responses. The patient was neurological symptom-free for 2 years. In addition, the abnormal enhancement of the frontal lobe observed on the initial brain MRI had disappeared. This report is meaningful of significance as because we used a minimal treatment of intrathecal chemotherapy, radiotherapy, allogeneic peripheral blood SCT and an oral TKI without using cytotoxic chemotherapy such as hyper-CyVAD.
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