Prophylaxis of central nervous system leukemia: a case of chronic myeloid leukemia with lymphoid blast crisis treated with imatinib mesylate.
BACKGROUND
Chronic myeloid leukemia (CML) in blast crisis has a dismal prognosis. Imatinib mesylate (IM) is a new drug which has been shown to induce complete hematological remission in 55% and complete cytogenetic response in 22% of the patients with CML in blast crisis.


METHODS
A child with CML in lymphoid blast crisis was diagnosed by complete hematological and bone marrow examination. There was no central nervous system (CNS) leukemia at presentation. The child was treated with IM at a daily dose of 400 mg.


RESULTS
The child showed remission after IM administration for 28 days and remained in remission till 59 days. On day 59 she experienced headache and vomiting. Results of cerebrospinal fluid taken for cytopathology showed CNS leukemia. MCP 841 protocol for ALL and weekly intrathecal triple therapy (ITT) was given.


CONCLUSIONS
Along with IM treatment in patients with CML in blast crisis, weekly ITT with hydrocortisone, cytosine arabinoside and methotrexate should be recommended to prevent CNS involvement.
Thavaraj
Vasantha
V
Pediatric Oncology Division, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. sowmyam.vasantha@gmail.com
Seth
Rachna
R
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001549:Benzamides; D001752:Blast Crisis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D001772:Blood Cell Count; D016543:Central Nervous System Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D018890:Chemoprevention / Q000379:methods; D002648:Child; D002985:Clinical Protocols; D003561:Cytarabine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D000068877:Imatinib Mesylate; D007278:Injections, Spinal; D008727:Methotrexate / Q000627:therapeutic use; D010879:Piperazines / Q000008:administration & dosage*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D011743:Pyrimidines / Q000008:administration & dosage*; D012074:Remission Induction
D000893:Anti-Inflammatory Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D003561:Cytarabine; D000068877:Imatinib Mesylate; D006854:Hydrocortisone; D008727:Methotrexate