What is the best salvage therapy for treatment of isolated CNS relapse in elderly patients with imatinib-responsive Ph(+) ALL?
We report the case of an elderly patient affected by Philadelphia positive Acute Lymphoblastic Leukaemia (Ph(+) ALL) who developed meningeal leukaemia during imatinib monotherapy, despite bone marrow molecular remission. Aggressive central nervous system (CNS)-directed therapy in combination with continued imatinib treatment might be, at the moment, the most effective salvage therapy for imatinib-responsive elderly patients with isolated CNS relapse. In view of the inefficacy of imatinib at preventing meningeal leukaemia for its poor penetration into the CNS, CNS prophylactic therapy should always be an integral part of any imatinib-based treatment strategy for Ph(+) ALL.
Mele
Giuseppe
G
Clinical Division of Haematology and BMT Unit, "Antonio Perrino" Hospital, Brindisi, Italy. giuseppemele@auslbr1.it
Pinna
Salvatore
S
Melpignano
Angela
A
Romano
Antonio
A
Brocca
Maurizio Claudio
MC
Coppi
Maria Rosaria
MR
Quarta
Giovanni
G
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001549:Benzamides; D001853:Bone Marrow / Q000187:drug effects / Q000473:pathology; D003561:Cytarabine / Q000008:administration & dosage; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D000068877:Imatinib Mesylate; D007278:Injections, Spinal; D008297:Male; D008577:Meningeal Neoplasms / Q000628:therapy*; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D010879:Piperazines / Q000627:therapeutic use*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000473:pathology / Q000628:therapy*; D011743:Pyrimidines / Q000627:therapeutic use*; D011878:Radiotherapy; D016879:Salvage Therapy
D000893:Anti-Inflammatory Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D003561:Cytarabine; D000068877:Imatinib Mesylate; D006854:Hydrocortisone; D008727:Methotrexate