title: Excellent response of chemotherapy-resistant B-cell-type chronic lymphocytic leukemia with meningeal involvement to rituximab.
abstract: A 70-year-old woman was diagnosed with B-cell-type chronic lymphocytic leukemia (B-CLL) in May 2001. Initial white blood cell (WBC) count was 37 x 10(9)/l and most of the cells were mature small lymphocytes. Surface antigen analysis of these lymphocytes revealed positive reactions for CD19, 20, 25, 5, and lambda-light chain. Despite her Rai stage-0 status, various treatments were ineffective, including cyclophosphamide; fludarabine; 6-mercaptopurine; a combination of vincristine, cyclophosphamide, prednisolone, and adriamycin; and etoposide. Her WBC count increased, ranging from 150 to 450 x 10(9)/l, with marked splenomegaly, and symptoms of meningitis, such as headache, ophthalmalgia, hearing disturbance, and abnormal behavior, being manifested. The WBC count in the cerebrospinal fluid was elevated to 134/microl. The surface phenotype of these cells was identical to that of circulating lymphocytes, indicating meningeal involvement of leukemia, a rare complication in B-CLL. At the time of this WBC elevation, 24% of circulating lymphocytes had prominent nucleoli, indicating progression of the disease to CLL/prolymphocytic leukemia. Her symptoms disappeared after repeated intrathecal injections of methotrexate and dexamethazone. After four courses of treatment of the refractory B-CLL with rituximab, an anti-CD20 monoclonal antibody, the WBC count returned to normal levels and the splenomegaly disappeared. She is currently well, with sustained remission, as of April 2004.
authors.affiliation: Department of Hematology and Clinical Immunology, Kobe City General Hospital, 4-6 Minatojima-Nakamachi, Kobe 650-0046, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Watanabe
authors.forename: Takayuki
authors.initials: T
authors.lastname: Takahashi
authors.forename: Naoshi
authors.initials: N
authors.lastname: Sugimoto
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kurata
authors.forename: Akiko
authors.initials: A
authors.lastname: Matsushita
authors.forename: Akinori
authors.initials: A
authors.lastname: Maeda
authors.forename: Kenichi
authors.initials: K
authors.lastname: Nagai
authors.forename: Kohji
authors.initials: K
authors.lastname: Nasu
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy / Q000628:therapy*; D008577:Meningeal Neoplasms / Q000628:therapy*; D000069283:Rituximab
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab