Meningeal relapse in Ph1-positive acute lymphoblastic and lymphoid blast crisis of chronic granulocytic leukemia. Is CNS-prophylaxis indicated?
Two cases of Ph1-positive acute lymphoblastic leukemia (ALL) and one case of lymphoid blast crisis (LyBc) of chronic granulocytic leukemia (CGL) treated with standard chemotherapy for ALL are presented. Hematologic remissions lasting 6, 12, and 15 months were achieved in all cases. Meningeal relapse occurred in all three, terminating remission in two cases and occurring immediately after systemic relapse in the third. No CNS-prophylaxis was given to the patient who relapsed at six months. Methotrexate (MTX) alone or combined with cranial irradiation formed the prophylaxis given in the other cases. Experience of these patients together with an analysis of reported cases of Ph1 ALL and CGL-LyBc suggests CNS-prophylaxis may prolong first remission. A large scale trial of this appears indicated.
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001921:Brain / Q000528:radiation effects; D002904:Chromosomes, Human, 21-22 and Y; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007945:Leukemia, Lymphoid / Q000188:drug therapy / Q000235:genetics / Q000473:pathology*; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008577:Meningeal Neoplasms / Q000517:prevention & control*; D008875:Middle Aged; D011379:Prognosis; D013116:Spinal Cord / Q000528:radiation effects
D000970:Antineoplastic Agents