title: Philadelphia chromosome-positive acute lymphoblastic leukemia with extramedullary and meningeal relapse after allogeneic hematopoietic stem cell transplantation that was successfully treated with dasatinib.
abstract: Central nervous system (CNS) relapse is a critical issue while treating Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph-positive ALL). A 58-year-old woman with Ph-positive ALL who relapsed after bone marrow transplantation for meningeal leukemia was treated with high-dose methotrexate, which resulted in remission. She underwent allogeneic cord blood transplantation followed by reduced intensity conditioning chemotherapy with imatinib; however, she experienced CNS relapse and developed an extramedullary mass on the right side of the temporal region. We treated 40 mg of dasatinib once daily, which had to be temporarily discontinued because she developed grade 2 pleural effusion and grade 2 hematemesis. After reinitiation of dasatinib, the extramedullary mass disappeared and meningeal leukemia ameliorated almost immediately. With 40 mg dasatinib administered once daily, its trough level and cerebrospinal fluid (CSF) concentration were 32 ng/mL and below the sensitivity threshold of 1 ng/mL, respectively. Treatment was continued, and the patient remained in complete remission until she died of pneumonia 7 years after the initial diagnosis of ALL. Dasatinib can be an effective treatment for Ph-positive ALL with CNS relapse. Although the concentration in the CSF seems low, it may be sufficient to exert anti-leukemic effects in the human CNS.
authors.affiliation: Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan.
authors.forename: Toshinori
authors.initials: T
authors.lastname: Kondo
authors.affiliation: Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan.
authors.forename: Taizo
authors.initials: T
authors.lastname: Tasaka
authors.affiliation: Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts, Kodo, Kyotanabe, Kyoto, 610-0395 Japan.
authors.forename: Kana
authors.initials: K
authors.lastname: Matsumoto
authors.affiliation: Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan.
authors.forename: Rui
authors.initials: R
authors.lastname: Matsumoto
authors.affiliation: Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan.
authors.forename: Lisa
authors.initials: L
authors.lastname: Koresawa
authors.affiliation: Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan.
authors.forename: Fuminori
authors.initials: F
authors.lastname: Sano
authors.affiliation: Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Tokunaga
authors.affiliation: Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Matsuhashi
authors.affiliation: Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Nakanishi
authors.affiliation: Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts, Kodo, Kyotanabe, Kyoto, 610-0395 Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Morita
authors.affiliation: Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan.
authors.forename: Hideho
authors.initials: H
authors.lastname: Wada
authors.affiliation: Division of Hematology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192 Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Sugihara
keywords: Dasatinib; Extramedullary relapse; Hematopoietic stem cell transplantation; Meningeal leukemia; Philadelphia chromosome-positive acute lymphoblastic leukemia