1
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Batayneh O, Lin A, Abu-Jaradeh O, Wu P, Villamar MF, Sharma P. Symptomatic leptomeningeal carcinomatosis: a rare presentation of chronic lymphocytic leukaemia relapse. BMJ Case Rep 2022; 15:e249940. [PMID: 35675961 PMCID: PMC9185480 DOI: 10.1136/bcr-2022-249940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2022] [Indexed: 11/03/2022] Open
Abstract
Central nervous system (CNS) involvement in patients with chronic lymphocytic leukaemia (CLL) is very rare and, when present, it is frequently asymptomatic. Rather, CNS involvement is more common in other haematological malignancies such as mantle cell lymphoma or diffuse large B cell lymphoma. The paucity of literature on CNS involvement in CLL underscores the importance of increasing awareness about its presentation, diagnosis and optimal management. We describe a case of symptomatic leptomeningeal leukaemic involvement as an atypical presentation of CLL relapse. A favourable clinical response was observed following systemic monotherapy with venetoclax.
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MESH Headings
- Adult
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Mantle-Cell
- Meningeal Carcinomatosis/diagnosis
- Neoplasm Recurrence, Local
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Affiliation(s)
- Osama Batayneh
- Department of Medicine, Kent Hospital/ The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Amy Lin
- OMS-III, University of New England College of Osteopathic Medicine, Warwick, RI, USA
| | - Omar Abu-Jaradeh
- Department of Medicine, Kent Hospital/ The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Peter Wu
- Department of Pathology, Kent Hospital, Warwick, RI, USA
| | - Mauricio F Villamar
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Medicine, Kent Hospital, Warwick, RI, USA
| | - Purva Sharma
- Department of Hematology and Oncology, Kent Hospital, Warwick, RI, USA
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2
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Optic nerve and spinal involvement associated with chronic lymphocytic leukemia. Rev Neurol (Paris) 2022; 178:742-744. [PMID: 35568517 DOI: 10.1016/j.neurol.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/23/2022]
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3
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Evans MG, Shestakova A, Haghighi N, Zhao X, Nardi V, Pinter-Brown LC, Rezk SA. Rare case of leptomeningeal small lymphocytic lymphoma with TP53 mutation detected by deep next-generation sequencing. Leuk Lymphoma 2022; 63:2479-2483. [DOI: 10.1080/10428194.2022.2070911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mark G. Evans
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anna Shestakova
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nahideh Haghighi
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Xiaohui Zhao
- Department of Pathology and Laboratory Medicine, University of California Irvine (UCI) Medical Center, Orange, CA, USA
| | - Valentina Nardi
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren C. Pinter-Brown
- Department of Medicine, Hematology/Oncology Division, University of California Irvine (UCI) Medical Center, Orange, CA, USA
| | - Sherif A. Rezk
- Department of Pathology and Laboratory Medicine, University of California Irvine (UCI) Medical Center, Orange, CA, USA
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4
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Maillie L, Salgado LR, Lazarev S. A systematic review of craniospinal irradiation for leptomeningeal disease: past, present, and future. Clin Transl Oncol 2021; 23:2109-2119. [PMID: 33881707 DOI: 10.1007/s12094-021-02615-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/30/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Leptomeningeal disease (LMD) is a rare but deadly complication of cancer in which the disease spreads to the cerebrospinal fluid and seeds the meninges of the central nervous system (CNS). Craniospinal irradiation (CSI) involves treatment of the entire CNS subarachnoid space and is occasionally used as a last-resort palliative therapy for LMD. METHODS This review examined literature describing the role of CSI for LMD from solid and hematologic malignancies in adults. A search for studies published until September 1, 2020 was conducted using PubMed database. RESULTS A total of 262 unique articles were identified. Thirteen studies were included for analysis in which a total of 275 patients were treated with CSI for LMD. Median age at time of irradiation was 43 years, and most patients had KPS score of 70 and higher. The most common cancers resulting in LMD were acute lymphocytic leukemia, breast cancer, and acute myelogenous leukemia. Median CSI dose was 30 Gy and 18% of patients were treated with proton radiation. 52% of patients had stable-to-improved neurologic symptoms. Median overall survival for the entire cohort was 5.3 months. Patients treated with marrow-sparing proton radiation had median OS of 8 months. The most common treatment toxicities were hematologic and gastrointestinal events. CONCLUSIONS Despite advances in systemic and radiation therapies, LMD remains a devastating end-stage complication of some malignancies. Treatment-related toxicities can be a significant barrier to CSI delivery. In select patients with LMD, marrow-sparing proton CSI may provide safer palliation of symptoms and prolong survival.
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Affiliation(s)
- L Maillie
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - L R Salgado
- Department of Radiation Oncology, Elmhurst Hospital, New York, NY, USA
| | - S Lazarev
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,New York Proton Center, New York, NY, USA.
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5
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Maleita D, Serras Pereira R, Hipolito-Fernandes D, Moura-Coelho N, Cunha JP, Tavares Ferreira J. Optic neuropathy due to chronic lymphocytic leukemia: The first manifestation of the disease. Am J Ophthalmol Case Rep 2020; 18:100603. [PMID: 32467860 PMCID: PMC7244917 DOI: 10.1016/j.ajoc.2020.100603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 12/20/2019] [Accepted: 01/05/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the western world. The involvement of the central nervous system (CNS) or the optic nerve in CLL, however, is rare. We report a case of a previously untreated patient with CLL whose first manifestation of the disease was a progressive visual loss caused by optic neuropathy. Observations Clinical manifestations, optical coherence tomography (OCT), and automated visual fields pointed to the diagnosis of neuropathy. Leukemic involvement of the CNS was confirmed after cells suggestive of CLL were found by cerebrospinal fluid analysis. Optic nerve infiltration is thought to be the cause of this optic neuropathy, and the clinical course and treatment are described herein. Conclusions When readily diagnosed, optic nerve infiltration is a rare, yet manageable complication of CLL.
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Affiliation(s)
- Diogo Maleita
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António dos Capuchos, 1169-050, Lisboa, Portugal
| | - Rita Serras Pereira
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António dos Capuchos, 1169-050, Lisboa, Portugal
| | - Diogo Hipolito-Fernandes
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António dos Capuchos, 1169-050, Lisboa, Portugal
| | - Nuno Moura-Coelho
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António dos Capuchos, 1169-050, Lisboa, Portugal.,Nova Medical School, Faculdade de Ciências Médicas, Campo Mártires da Pátria 130, 1169-056, Lisboa, Portugal
| | - João Paulo Cunha
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António dos Capuchos, 1169-050, Lisboa, Portugal.,Nova Medical School, Faculdade de Ciências Médicas, Campo Mártires da Pátria 130, 1169-056, Lisboa, Portugal
| | - Joana Tavares Ferreira
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António dos Capuchos, 1169-050, Lisboa, Portugal.,Nova Medical School, Faculdade de Ciências Médicas, Campo Mártires da Pátria 130, 1169-056, Lisboa, Portugal
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6
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Beziat G, Gauthier M, Protin C, Oberic L, Lerebours F, Carlier J, Ysebaert L. Venetoclax with high-dose methotrexate and rituximab seem effective and well-tolerated in the treatment of central nervous system involvement of chronic lymphocytic leukemia: A case report. Clin Case Rep 2020; 8:269-273. [PMID: 32128171 PMCID: PMC7044374 DOI: 10.1002/ccr3.2580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/25/2019] [Accepted: 10/26/2019] [Indexed: 12/14/2022] Open
Abstract
Venetoclax with high-dose methotrexate and rituximab seem effective and safe to treat central nervous system involvement of chronic lymphocytic leukemia.
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Affiliation(s)
- Guillaume Beziat
- Department of HematologyInstitut Universitaire du Cancer de Toulouse‐OncopoleToulouseFrance
| | - Martin Gauthier
- Department of HematologyInstitut Universitaire du Cancer de Toulouse‐OncopoleToulouseFrance
| | - Caroline Protin
- Department of HematologyInstitut Universitaire du Cancer de Toulouse‐OncopoleToulouseFrance
| | - Lucie Oberic
- Department of HematologyInstitut Universitaire du Cancer de Toulouse‐OncopoleToulouseFrance
| | | | | | - Loïc Ysebaert
- Department of HematologyInstitut Universitaire du Cancer de Toulouse‐OncopoleToulouseFrance
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7
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Akdogan O, Guven T, Altindal S, Erdal Y, Emre U. An uncommon neurological manifestation of chronic lymphocytic leukemia: Longitudinally extensive transverse myelitis. Mult Scler Relat Disord 2019; 37:101455. [PMID: 31670207 DOI: 10.1016/j.msard.2019.101455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/04/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
We describe a 50-year-old male patient who was admitted to the emergency department with complaints of fever and fatigue that had suddenly started two weeks ago. In the laboratory evaluation, a white blood cell count of 131.000/mm3 was detected. The patient was hospitalized and developed fecal incontinence on the first day of hospitalization. Detailed neurological examination revealed the patient had tetraparesis. Long segment high signal intensity was observed on spinal MRI. Flow cytometry examination of the CSF and biopsy findings of the bone marrow were compatible with Chronic Lymphocytic Leukemia (CLL). The patient's MRI appearances resolved after treatment. The tetraparesis resolved partially. There was no motor deficit in upper extremities and the patient was able to walk without aid or rest for 100 m. Clinical manifestation of central nervous system (CNS) involvement in CLL is heterogeneous and therefore may be difficult to pinpoint. We have described an uncommon occurrence of CNS involvement in CLL.
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Affiliation(s)
- Ozlem Akdogan
- Istanbul Training and Research Hospital, Neurology Department, Turkey
| | - Tugce Guven
- Istanbul Training and Research Hospital, Neurology Department, Turkey
| | - Sermin Altindal
- Istanbul Training and Research Hospital, Hematology Department, Turkey
| | - Yuksel Erdal
- Istanbul Training and Research Hospital, Neurology Department, Turkey.
| | - Ufuk Emre
- Istanbul Training and Research Hospital, Neurology Department, Turkey
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8
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Naydenov AV, Taylor LP. Leptomeningeal Carcinomatosis in Chronic Lymphocytic Leukemia: A Case Report and Review of the Literature. Oncologist 2019; 24:1237-1245. [PMID: 30842245 DOI: 10.1634/theoncologist.2018-0619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 01/25/2019] [Indexed: 11/17/2022] Open
Abstract
Leptomeningeal disease is a rare complication of chronic lymphocytic leukemia (CLL). We report a case of leptomeningeal disease in CLL with a complete clinical response and clearance of cerebral spinal fluid (CSF) after treatment with ibrutinib and intrathecal rituximab. In a comprehensive review of the published literature since 1976, we found 136 cases of CLL with leptomeningeal spread. We found that leptomeningeal disease in patients with CLL responds favorably to treatment in most cases and is associated with longer overall survival than is expected for other cancers. Clearance of CSF is associated with improved survival. Treatment with rituximab and ibrutinib is more frequently associated with complete response compared with older agents. IMPLICATIONS FOR PRACTICE: The incidence of leptomeningeal CLL is more common than previously described and can be recognized by attention to certain symptoms and signs. This case presentation and literature review reveals that, in many cases, leptomeningeal lymphomatosis is reversible with the use of rituximab and ibrutinib. The authors show a survival benefit associated with treating to cerebral spinal fluid (CSF) clearance by cytology and compare outcomes with various treatment strategies, focusing on novel agents. Now that there is effective therapy for leptomeningeal lymphoma in CLL, the importance for oncologists to recognize this neurologic complication has become clear.
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MESH Headings
- Adenine/analogs & derivatives
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/cerebrospinal fluid
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Male
- Meningeal Carcinomatosis/cerebrospinal fluid
- Meningeal Carcinomatosis/complications
- Meningeal Carcinomatosis/diagnosis
- Meningeal Carcinomatosis/drug therapy
- Middle Aged
- Piperidines
- Pyrazoles/administration & dosage
- Pyrimidines/administration & dosage
- Remission Induction
- Rituximab/administration & dosage
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Affiliation(s)
- Alipi V Naydenov
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Lynne P Taylor
- Department of Neurology, University of Washington, Seattle, Washington, USA
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
- Alvord Brain Tumor Center, University of Washington, Seattle, Washington, USA
- Seattle Cancer Care Alliance, Seattle, Washington, USA
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9
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Central nervous system localisation of chronic lymphocytic leukaemia, description of two very distinct cases and a review of the literature. Ann Hematol 2018; 97:1627-1632. [PMID: 29707738 PMCID: PMC6097746 DOI: 10.1007/s00277-018-3329-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/04/2018] [Indexed: 11/01/2022]
Abstract
Central nervous system (CNS) localisation of chronic lymphocytic leukaemia (CLL) can induce various neurological symptoms. Unfamiliarity with this manifestation causes diagnostic delay. We present two cases of leptomeningeal CLL. These cases and our literature review emphasise that CNS localisation of CLL should be considered in patients with any neurological symptom, irrespectively of the stage and systemic activity of CLL.
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10
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Comprehensive craniospinal radiation for controlling central nervous system leukemia. Int J Radiat Oncol Biol Phys 2015; 90:1119-25. [PMID: 25539370 DOI: 10.1016/j.ijrobp.2014.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/18/2014] [Accepted: 08/02/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the benefit of radiation therapy (RT) in resolution of neurologic symptoms and deficits and whether the type of RT fields influences central nervous system (CNS) control in adults with CNS leukemia. METHODS AND MATERIALS A total of 163 adults from 1996 to 2012 were retrospectively analyzed. Potential associations between use of radiation and outcome were investigated by univariate and multivariate analysis. RESULTS The median survival time was 3.8 months after RT. Common presenting symptoms were headache in 79 patients (49%), cranial nerve VII deficit in 46 (28%), and cranial nerve II deficit in 44 (27%). RT was delivered to the base of skull in 48 patients (29%), to the whole brain (WB) in 67 (41%), and to the craniospinal axis (CS) in 48 (29%). Among 149 patients with a total of 233 deficits, resolution was observed in 34 deficits (15%), improvement in 126 deficits (54%), stability in 34 deficits (15%), and progression in 39 deficits (17%). The 12-month CNS progression-free survival was 77% among those receiving CS/WB and 51% among those receiving base of skull RT (P=.02). On multivariate analysis, patients who did not undergo stem cell transplantation after RT and base of skull RT were associated with worse CNS progression-free survival. CONCLUSIONS Improvement or resolution of symptoms occurred in two thirds of deficits after RT. Comprehensive radiation to the WB or CS seems to offer a better outcome, especially in isolated CNS involvement.
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11
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de Souza SL, Santiago F, Ribeiro-Carvalho MDM, Arnóbio A, Soares AR, Ornellas MH. Leptomeningeal involvement in B-cell chronic lymphocytic leukemia: a case report and review of the literature. BMC Res Notes 2014; 7:645. [PMID: 25218117 PMCID: PMC4246480 DOI: 10.1186/1756-0500-7-645] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/08/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Central nervous system involvement is considered a rare complication of chronic lymphocytic leukemia, and so there is the risk of being overlooked. CASE PRESENTATION We report a case of central nervous system involvement in a 75-year-old mulatto woman with chronic lymphocytic leukemia after 5 years of follow-up and a literature review on the subject. The clinical course, treatment and outcome are described. A systematic, meticulous and comprehensive analysis of existing publications regarding chronic lymphocytic leukemia with central nervous system involvement was performed. CONCLUSION We concluded that central nervous system involvement of chronic lymphocytic leukemia is probably not associated with any evident risk factors. Diagnostic approach differs by institutions but often includes imaging, morphology and flow cytometry. Resolution of central nervous system symptoms can usually be accomplished with intrathecal chemotherapy or irradiation followed by systemic treatment. The recognition of this entity by clinicians could lead to early detection and treatment, resulting in better outcomes in this rare complication.
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Affiliation(s)
- Simone Lima de Souza
- />Departamento de Patologia, Faculdade de Ciências Medicas, Programa de Pós Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, 444/4° andar, Vila Isabel, Rio de Janeiro Brazil
| | - Fábio Santiago
- />Departamento de Patologia, Faculdade de Ciências Medicas, Programa de Pós Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, 444/4° andar, Vila Isabel, Rio de Janeiro Brazil
| | - Marilza de Moura Ribeiro-Carvalho
- />Departamento de Patologia, Faculdade de Ciências Medicas, Programa de Pós Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, 444/4° andar, Vila Isabel, Rio de Janeiro Brazil
| | - Adriano Arnóbio
- />Departamento de Patologia, Faculdade de Ciências Medicas, Programa de Pós Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, 444/4° andar, Vila Isabel, Rio de Janeiro Brazil
| | - Andréa Ribeiro Soares
- />Serviço de Hematologia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Helena Ornellas
- />Departamento de Patologia, Faculdade de Ciências Medicas, Programa de Pós Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, 444/4° andar, Vila Isabel, Rio de Janeiro Brazil
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12
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Ratterman M, Kruczek K, Sulo S, Shanafelt TD, Kay NE, Nabhan C. Extramedullary chronic lymphocytic leukemia: systematic analysis of cases reported between 1975 and 2012. Leuk Res 2013; 38:299-303. [PMID: 24064196 DOI: 10.1016/j.leukres.2013.08.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/16/2013] [Accepted: 08/17/2013] [Indexed: 11/26/2022]
Abstract
The prognostic significance of extra-medullary chronic lymphocytic leukemia (EM-CLL) is unknown. We conducted a Medline database systematic search analyzing English language articles published between 1975 and 2012 identifying 192 cases. Patients with EM-CLL were more commonly treated than not (p < .001). Skin and central nervous system (CNS) were the most commonly reported sites of organ involvement. Survival after diagnosis of EM-CLL appeared to depend on the site of EM involvement. Prospective evaluation and further studies of EM-CLL are warranted.
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Affiliation(s)
- Megan Ratterman
- Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, IL, United States
| | - Kimberly Kruczek
- Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, IL, United States
| | - Suela Sulo
- James R. & Helen D. Russell Institute for Research & Innovation, Advocate Lutheran General Hospital, Park Ridge, IL, United States
| | - Tait D Shanafelt
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Neil E Kay
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Chadi Nabhan
- Department of Medicine, Section of Hematology and Oncology, The University of Chicago, Chicago, IL, United States.
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13
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Garala K, Jayaramachandran P, Knopp M, Critchley P. Orbital apex tumour caused by chronic lymphocytic leukaemia: an unlikely suspect. BMJ Case Rep 2013; 2013:bcr-2013-200166. [PMID: 23843418 DOI: 10.1136/bcr-2013-200166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 88-year-old woman with a background of chronic lymphocytic leukaemia (CLL) and presented with unilateral ptosis and dull facial pains for 1 month. Examination revealed a complete right-sided ptosis and pupillary dilation. Vision in her right eye was limited to light perception. She had total external ophthalmoplegia. Her corneal reflex was not present in her right eye and she had lost sensation on the right side of her forehead. MRI revealed abnormal enhancement in the right orbital apex extending posteriorly to the sphenoid sinus. The mass invaded the superior orbital fissure, optic canal and cavernous sinus. The lumbar puncture was normal. Owing to the proximity of the mass to the cavernous sinus, it was deemed that surgical excision of the tumour was unsafe; however, it was amenable to biopsy. Histology of the biopsies was consistent with CLL. The patient declined to undergo single high-dose radiotherapy followed by dexamethasone.
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14
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Palma JA, Fernandez-Torron R, Esteve-Belloch P, Fontes-Villalba A, Hernandez A, Fernandez-Hidalgo O, Gallego Perez-Larraya J, Martinez-Vila E. Leptomeningeal carcinomatosis: Prognostic value of clinical, cerebrospinal fluid, and neuroimaging features. Clin Neurol Neurosurg 2013; 115:19-25. [DOI: 10.1016/j.clineuro.2012.03.048] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 03/25/2012] [Accepted: 03/31/2012] [Indexed: 11/17/2022]
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15
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Grisold W, Briani C, Vass A. Malignant cell infiltration in the peripheral nervous system. HANDBOOK OF CLINICAL NEUROLOGY 2013; 115:685-712. [PMID: 23931810 DOI: 10.1016/b978-0-444-52902-2.00040-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The peripheral nervous system can be affected by malignancies involving different mechanisms. Neoplastic nerve lesion by compression, invasion, and infiltration is rare and occurs in particular in leukemia (neuroleukemiosis) and lymphoma (neurolymphomatosis). Its occurrence is much rarer in cancer, and even less so in sarcoma. The neoplastic infiltration of peripheral nerves by solid tumors is characterized by specific topographical sites such as the base of the skull, the ear, nose and throat region, and the cervico-brachial plexus as well as the lumbar and sacral plexus. Rarely malignant invasion affects the cranial nerves of the face where it can spread centripetally. Autonomic nerves and ganglia can also be affected. The retrograde spread of cancer in nerves is a bad prognostic sign. The clinical diagnosis is determined by tumor type, the pattern of involvement, and often pain.
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Affiliation(s)
- W Grisold
- Department of Neurology, Kaiser-Franz-Josef Hospital, Austrian Cluster for Tissue Regeneration and Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.
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16
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Cohen JB, Cavaliere R, Byrd JC, Andritsos LA. Hearing Loss due to Infiltration of the Tympanic Membrane by Chronic Lymphocytic Leukemia. Case Rep Hematol 2012; 2012:589718. [PMID: 23198191 PMCID: PMC3502771 DOI: 10.1155/2012/589718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 10/16/2012] [Indexed: 11/30/2022] Open
Abstract
Central nervous system (CNS) involvement by chronic lymphocytic leukemia (CLL) can present with dramatic neurologic findings or can be quite subtle, discovered only at the time of autopsy. We describe a case of CLL in a patient who presented initially with hearing loss and was ultimately found to have involvement of the tympanic membrane. She noted improvement of her hearing after induction therapy but was not aware at the time of the involvement of her CNS with CLL. Upon worsening of hearing at the time of relapse, she was evaluated by imaging and CSF analysis as well as biopsy of the tympanic membrane, and involvement of the CNS was confirmed. She has received CNS-directed therapy with intrathecal liposomal cytarabine and intravenous CNS-directed therapy and has noted improved hearing and resolution of her imaging and CSF findings. This is the first reported case of tympanic membrane involvement with CLL and describes potentially effective methods for managing this challenging complication.
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Affiliation(s)
- Jonathon B. Cohen
- Division of Hematology, The Arthur G. James Comprehensive Cancer Center and The Ohio State University, 320 W 10th Avenue, B354 Starling Loving Hall, Columbus, OH 43210, USA
| | - Robert Cavaliere
- Department of Neurosurgery, The Arthur G. James Comprehensive Cancer Center and The Ohio State University, Columbus, OH 43210, USA
| | - John C. Byrd
- Division of Hematology, The Arthur G. James Comprehensive Cancer Center and The Ohio State University, 320 W 10th Avenue, B354 Starling Loving Hall, Columbus, OH 43210, USA
| | - Leslie A. Andritsos
- Division of Hematology, The Arthur G. James Comprehensive Cancer Center and The Ohio State University, 320 W 10th Avenue, B354 Starling Loving Hall, Columbus, OH 43210, USA
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17
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Reddy CG, Mauermann ML, Solomon BM, Ringler MD, Jerath NU, Begna KH, Amrami KK, Spinner RJ. Neuroleukemiosis: an unusual cause of peripheral neuropathy. Leuk Lymphoma 2012; 53:2405-11. [DOI: 10.3109/10428194.2012.691480] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Spectrum of neurologic complications in chronic lymphocytic leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 12:164-79. [PMID: 22192500 DOI: 10.1016/j.clml.2011.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Revised: 10/19/2011] [Accepted: 10/27/2011] [Indexed: 12/21/2022]
Abstract
Neurologic disease is believed to be an unusual complication during the course of chronic lymphocytic leukemia. Nevertheless, it has already been proven in autopsy series that the incidence of occult nervous system infiltration is much higher than was previously expected. The advent of more potent drugs to treat this lymphoproliferative disorder has brought a new hope for a possible cure in the future. However, an appropriate systemic treatment for central nervous system infiltration of this disease is still lacking. Also, due to the potent immunosuppressive properties of the agents used in the up-front treatment, for example, the purine nucleoside analogues, we have witnessed an increase in the incidence of opportunistic infections, with progressive multifocal leukoencephalopathy being one of the most serious. The goal of this review is to summarize the spectrum of neurologic derangements linked to chronic lymphocytic leukemia and to raise clinicians' awareness to recognize the possibility of such associations.
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19
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Tonino SH, Rijssenbeek AL, Oud ME, Pals ST, van Oers MH, Kater AP. Intracerebral Infiltration As the Unique Cause of the Clinical Presentation of Chronic Lymphocytic Leukemia/Small Lymphocytic Leukemia. J Clin Oncol 2011; 29:e837-9. [DOI: 10.1200/jco.2011.37.5055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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20
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Ackermann KA, Z'Graggen WJ, El-Koussy M, Caversaccio M, Vajtai I, Colucci G. Blindness in a patient with chronic lymphocytic leukemia. Am J Hematol 2011; 86:783-4. [PMID: 21630303 DOI: 10.1002/ajh.22042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 03/22/2011] [Accepted: 03/24/2011] [Indexed: 11/09/2022]
Affiliation(s)
- Karin A Ackermann
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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21
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Moazzam AA, Drappatz J, Kim RY, Kesari S. Chronic lymphocytic leukemia with central nervous system involvement: report of two cases with a comprehensive literature review. J Neurooncol 2011; 106:185-200. [PMID: 21769650 DOI: 10.1007/s11060-011-0636-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 06/17/2011] [Indexed: 10/18/2022]
Abstract
Central nervous system (CNS) involvement is a rare complication of chronic lymphocytic leukemia (CLL) with varied outcomes. We contribute two additional cases of CLL with CNS involvement. The clinical course and response to treatment are described. All 78 previously reported cases of CLL with CNS involvement are presented in this comprehensive review of the literature. CNS involvement of CLL is a rare complication that does not seem to correlate with any evident risk factors. Resolution of CNS symptoms can often be accomplished with intrathecal chemotherapy or irradiation. Early detection and treatment may result in better outcomes in this rare complication.
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MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor
- Central Nervous System Neoplasms/drug therapy
- Central Nervous System Neoplasms/pathology
- Central Nervous System Neoplasms/radiotherapy
- Combined Modality Therapy
- Fatal Outcome
- Female
- Flow Cytometry
- Gait Disorders, Neurologic/etiology
- Humans
- Hypesthesia/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/radiotherapy
- Leukemic Infiltration
- Leukocyte Count
- Magnetic Resonance Imaging
- Middle Aged
- Tomography, X-Ray Computed
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Affiliation(s)
- Alan A Moazzam
- Department of Neurosciences, Moores UCSD Cancer Center, University of California at San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093, USA
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22
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Affiliation(s)
- Julie G Walker
- University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
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23
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Calvo-Villas JM, Fernández JA, De La Fuente I, Godoy AC, Mateos MC, Poderós C. Intrathecal liposomal cytarabine for treatment of leptomeningeal involvement in transformed (Richter’s syndrome) and non-transformed B-cell chronic lymphocytic leukaemia in Spain: a report of seven cases. Br J Haematol 2010; 150:618-20. [DOI: 10.1111/j.1365-2141.2010.08238.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Agarwal S, Gabriel CM, Campbell VL, Marks S. Steroid responsive metastatic epidural nerve root infiltration with chronic lymphocytic leukaemia. QJM 2010; 103:55-6. [PMID: 19531729 DOI: 10.1093/qjmed/hcp074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Agarwal
- Department of Neurology, St. Mary's Hospital, Imperial College NHS Trust, Paddington, London W2 1NY, UK.
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25
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Pamuk GE, Puyan FO, Unlü E, Oztürk E, Demir M. The first case of de novo B-cell prolymphocytic leukemia with central nervous system involvement: description of an unreported complication. Leuk Res 2008; 33:864-7. [PMID: 18929411 DOI: 10.1016/j.leukres.2008.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 09/01/2008] [Accepted: 09/02/2008] [Indexed: 11/30/2022]
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