Isolated central nervous system blast crisis in chronic myeloid leukemia under treatment with dasatinib. A case report and literature review
DOI:
https://doi.org/10.35509/01239015.836Palabras clave:
blast crisis, chronic myeloid leukemia, central nervous systemResumen
Chronic myeloid leukemia (CML) is a disease that occurs in three phases: chronic, accelerated, and blast crisis. Blast crisis is diagnosed when there are 20% or more blasts in the bone marrow or extramedullary blast infiltration, frequently in the form of myeloid sarcoma. Isolated central nervous system blast crisis is very rare and even more in patients treated with dasatinib, which has good penetrance at this level. We present the case of a 61-year-old patient with a long-term diagnosis of CML under treatment with dasatinib, maintaining a major molecular response, who consulted for headaches and seizures, ruling out anatomical and infectious causes. CSF analysis showed the presence of blasts with a normal bone marrow biopsy, which led to the diagnosis of isolated central nervous system blast crisis. Dasatinib treatment continued at a higher dose, and an intrathecal chemotherapy regimen with Ommaya reservoir was established, with excellent results. Isolated central nervous system blast crisis is rare; most cases have been reported under treatment with imatinib, which has low penetrance at this level. There is only one case in the literature of blast crisis treated with dasatinib, and it has lymphoid origin. Management is not well established due to limited literature on the subject. Multicenter studies are required to delineate an adequate treatment in this case type.
Biografía del autor/a
Humberto Martínez-Cordero, El Bosque University, Bogotá, D.C., Colombia.
1. El Bosque University, Bogotá, D.C., Colombia.
2. Hematology and Bone Marrow Transplantation Unit, National Cancer Institute, Bogotá, D.C., Colombia.
Roberto Ramos-Córdoba, Hematology and Bone Marrow Transplantation Unit, National Cancer Institute, Bogotá, D.C., Colombia.
2. Hematology and Bone Marrow Transplantation Unit, National Cancer Institute, Bogotá, D.C., Colombia.
Rafael Gaitán-Aroca, Hematology and Bone Marrow Transplantation Unit, National Cancer Institute, Bogotá, D.C., Colombia.
2. Hematology and Bone Marrow Transplantation Unit, National Cancer Institute, Bogotá, D.C., Colombia.
Andrea García-B., Hematology and Bone Marrow Transplantation Unit, National Cancer Institute, Bogotá, D.C., Colombia.
2. Hematology and Bone Marrow Transplantation Unit, National Cancer Institute, Bogotá, D.C., Colombia.
Sandra Chinchilla, Hematopathology Department, National Cancer Institute, Bogotá, D.C., Colombia.
3. Hematopathology Department, National Cancer Institute, Bogotá, D.C., Colombia.
Giovana Bedón, Hematopathology Department, National Cancer Institute, Bogotá, D.C., Colombia.
3. Hematopathology Department, National Cancer Institute, Bogotá, D.C., Colombia.
Isabella Novoa-Caicedo, El Bosque University, Bogotá, D.C., Colombia.
1. El Bosque University, Bogotá, D.C., Colombia.
Referencias bibliográficas
WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, revised 4th edition, Swerdlow SH, Campo E, Harris NL, et al. (Eds), International Agency for Research on Cancer (IARC), Lyon 2017. Available from: https://www.iarc.who.int/news-events/who-classification-of-tumoursof-haematopoietic-and-lymphoid-tissues-2/
Sawyers CL. Chronic myeloid leukemia. N Engl J Med. 1999;340(17):1330-40. https://doi.org/10.1056/NEJM199904293401706
Martinez-Cordero H, Patiño-Escobar B, Enciso L, Otero D, Spirko P. Myelomastocytic blast cell crisis in resistant tyrosine kinase inhibitor chronic myelogenous leukemia: Case report and review of literature. Cureus. 2019;11(5):e4703. https://doi.org/10.7759/cureus.4703
Radich JP. The Biology of CML blast crisis. Hematology Am Soc Hematol Educ Program. 2007;1:384-91. https://doi.org/10.1182/asheducation-2007.1.384
Hehlmann R. How I treat CML blast crisis. Blood. 2012;120(4):737-47. https://doi.org/10.1182/blood-2012-03-380147
Rajappa S, Uppin SG, Raghunadharao D, Rao IS, Surath A. Isolated central nervous system blast crisis in chronic myeloid leukemia. Hematol Oncol. 2004;22(4):179–81. https://doi.org/10.1002/hon.737
Jin M, Xuan C, Gao J, Han R, Xu S, Wang L, et al. Chronic myeloid leukemia extramedullary blast crisis presenting as central nervous system leukemia: A case report: A case report. Medicine (Baltimore). 2018;97(45):e13131. https://doi.org/10.1097/MD.0000000000013131
Porkka K, Koskenvesa P, Lund'an T, Rimpiläinen J, Mustjoki S, Smykla R et al. Dasatinib crosses the blood-brain barrier and is an efficient therapy for central nervous system Philadelphia chromosome-positive leukemia. Blood. 2008;112(4):1005-12. https://doi.org/10.1182/blood-2008-02-140665
Boudiaf H, Ezziane K, Rouis N O, Himrane M, Hakem S, Benchabane H, et al. Isolated blast crisis relapse in the central nervous system of a patient treating for a chronic myelogenous leukemia. Pan Afr Med J. 2020;36:142. https://doi.org/10.11604/pamj.2020.36.142.24155
Radhika N, Minakshi M, Rajesh M, Manas BR, Deepak Kumar M. Central nervous system blast crisis in chronic myeloid leukemia on imatinib mesylate therapy: report of two cases. Indian J Hematol Blood Transfus. 2011;27(1):51-4. https://doi.org/10.1007/s12288-011-0055-5
Abuelgasim KA, Alshieban S, Almubayi NA, Alhejazi A, Jazieh AR. An atypical initial presentation of chronic myeloid leukemia with central nervous system and lymph node blast crises. Case Rep Oncol. 2016;9(2):415-21. https://doi.org/10.1159/000447711
Lindhorst SM, Lopez RD, Sanders RD. An unusual presentation of chronic myelogenous leukemia: a review of isolated central nervous system relapse. J Natl Compr Canc Netw. 2013;11(7):745-9. https://doi.org/10.6004/jnccn.2013.0097
Zhou HS, Dai M, Wei Y, Wang Q, Xu N, Yin C, et al. Isolated central nervous system relapse in patient with blast-crisis chronic myeloid leukemia in durable complete cytogenetic remission on dasatinib treatment: pharmacokinetics and ABL mutation analysis in cerebrospinal fluid. Leuk Lymphoma. 2013;54(7):1557-9. https://doi.org/10.3109/10428194.2012.745933
De Reuck J, De Coster W, vander Eecken H. Communicating hydrocephalus in treated leukemic patients. Eur Neurol. 1979;18(1):8-14. https://doi.org/10.1159/000115047
Cómo citar
Descargas
Descargas
Publicado
Número
Sección
Licencia
Derechos de autor 2022 Revista Colombiana de Cancerología
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
Todos los derechos reservados.
Estadísticas de artículo | |
---|---|
Vistas de resúmenes | |
Vistas de PDF | |
Descargas de PDF | |
Vistas de HTML | |
Otras vistas |