CNS blast crisis of chronic myelogenous leukemia in a patient with a major cytogenetic response in bone marrow associated with low levels of imatinib mesylate and its N-desmethylated metabolite in cerebral spinal fluid.
Imatinib mesylate (STI571) is a very effective treatment option for Ph(+) chronic myeloid leukemia (CML) in chronic phase. Secondary treatment failures have mostly been observed in patients with advanced stages of disease. We report the case of a patient who unexpectedly experienced blast crisis of the central nervous system although having achieved complete cytogenetic remission in the bone marrow. The levels of STI571 and its metabolite N-desmethyl STI were 40-fold lower in the cerebral spine fluid than in plasma. The risk of CNS disease has to be kept in mind when patients with CML in chronic phase who are at an increased risk for blastic transformation are treated with imatinib mesylate.
Bornhauser
Martin
M
Med. Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany. bornhaeuser@uniklinikum-dresden.de
Jenke
Andreas
A
Freiberg-Richter
Jens
J
Radke
Jörgen
J
Schuler
Ulrich S
US
Mohr
Brigitte
B
Ehninger
Gerhard
G
Schleyer
Eberhard
E
D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000134:cerebrospinal fluid*; D001549:Benzamides; D001752:Blast Crisis / Q000235:genetics*; D001853:Bone Marrow / Q000473:pathology*; D002490:Central Nervous System / Q000473:pathology*; D005260:Female; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000235:genetics / Q000473:pathology*; D008875:Middle Aged; D010879:Piperazines / Q000008:administration & dosage / Q000134:cerebrospinal fluid*; D011743:Pyrimidines / Q000008:administration & dosage / Q000134:cerebrospinal fluid*; D012074:Remission Induction
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate