title: Central nervous system relapse in a patient with acute promyelocytic leukaemia: does the risk stratification matter?
abstract: Extramedullary relapse is an uncommon complication of acute promyelocytic leukaemia (APL). The most common site of extramedullary relapse is the central nervous system (CNS), and the majority of CNS relapses occur in patients with high-risk disease in which white blood cell count at presentation is greater than 10×10(3)/μL. The best management of such patients is still controversial. We describe a 47-year-old man with APL who developed two CNS relapses which were diagnosed through the presence of t(15;17)(q22;q21) on PCR of the cerebrospinal fluid (CSF), despite presenting initially with intermediate-risk disease. We conclude that the intermediate risk group is very heterogeneous and these patients sometimes may behave like high-risk patients. Also, clinicians should take into account symptoms that can be related to CNS relapse in patients with APL and consider lumbar puncture even if radiological imaging does not reveal anything.
authors.affiliation: Department of Hematology, Eskisehir Osmangazi University, Eskisehir, Turkey. drdenizgoren@gmail.com
authors.forename: Deniz Goren
authors.initials: DG
authors.lastname: Sahin
authors.forename: Eren
authors.initials: E
authors.lastname: Gunduz
authors.forename: Olga Meltem
authors.initials: OM
authors.lastname: Akay
authors.forename: Zafer
authors.initials: Z
authors.lastname: Gulbas
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016543:Central Nervous System Neoplasms / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000235:genetics / Q000473:pathology*; D002884:Chromosomes, Human, Pair 15; D002886:Chromosomes, Human, Pair 17; D017809:Fatal Outcome; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000235:genetics / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012008:Recurrence; D012307:Risk Factors; D014178:Translocation, Genetic