title: Central nervous system lesions due to juvenile myelomonocytic leukemia progressed in a boy undergoing first line chemotherapy.
abstract: Juvenile myelomonocytic leukemia is a rare malignancy that occurs in pediatric patients. Previous reports, have described leukemic cells may infiltrate many organs, such as the lungs, skin, liver, spleen, and intestines, but not the central nervous system, although central nervous system infiltration remains a point of concern in every patient with acute leukemia. Here, we present one case of a boy with juvenile myelomonocytic leukemia who developed multiple lesions in the brain while undergoing chemotherapy with 6-mercaptopurine and cytarabine. We diagnosed the central nervous system involvement by magnetic resonance imaging, cerebrospinal fluid cytology, and the patient's clinical course. He was treated with a high dose of cytarabine and intrathecal chemotherapy, then with unrelated cord blood stem cell transplantation. He has been in a first complete remission for more than 18 months after cord blood stem cell transplantation without any neurological sequelae. In conclusion, we encountered a boy with juvenile myelomonocytic leukemia who developed central nervous system lesions under standard chemotherapy. We subsequently switched treatment to central nervous system-oriented chemotherapy, which resulted in a good clinical condition and successful cord blood stem cell transplantation.
authors.affiliation: Department of Pediatrics, Tsukuba University Hospital, Tsukuba, Japan. fukushima-tuk@umin.ac.jp
authors.forename: Hiroko
authors.initials: H
authors.lastname: Fukushima
authors.forename: Takashi
authors.initials: T
authors.lastname: Fukushima
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Hiraki
authors.forename: Ryoko
authors.initials: R
authors.lastname: Suzuki
authors.forename: Shaza S A
authors.initials: SS
authors.lastname: Mahmoud
authors.forename: Ai
authors.initials: A
authors.lastname: Yoshimi
authors.forename: Tomohei
authors.initials: T
authors.lastname: Nakao
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kato
authors.forename: Chie
authors.initials: C
authors.lastname: Kobayashi
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Koike
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Fukasawa
authors.forename: Yukio
authors.initials: Y
authors.lastname: Morishita
authors.forename: Sayoko
authors.initials: S
authors.lastname: Doisaki
authors.forename: Hideki
authors.initials: H
authors.lastname: Muramatsu
authors.forename: Ryo
authors.initials: R
authors.lastname: Sumazaki
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D001921:Brain / Q000187:drug effects* / Q000473:pathology*; D003561:Cytarabine / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D054429:Leukemia, Myelomonocytic, Juvenile / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D008297:Male; D015122:Mercaptopurine / Q000009:adverse effects*; D033581:Stem Cell Transplantation
chemical_list: D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine; D015122:Mercaptopurine