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For: MacLean H, Clarke MP, Strong NP, Kernahan J, Ashraf S. Primary ocular relapse in acute lymphoblastic leukemia. Eye (Lond) 1996;10 ( Pt 6):719-22. [PMID: 9091369 DOI: 10.1038/eye.1996.167] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open

For:	MacLean H, Clarke MP, Strong NP, Kernahan J, Ashraf S. Primary ocular relapse in acute lymphoblastic leukemia. Eye (Lond) 1996;10 ( Pt 6):719-22. [PMID: 9091369 DOI: 10.1038/eye.1996.167] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open

Number

Cited by Other Article(s)

Denier M, Tick S, Dubois R, Dulery R, Eller AW, Suarez F, Burroni B, Maurage CA, Bories C, Konopacki J, Puech M, Bouscary D, Cantalloube A, Héron E, Marçais A, Habas C, Theillac V, Keilani C, Bonhomme GR, Gallagher DS, Boumendil J, Abarah W, Sedira N, Bertin S, Choquet S, Sahel JA, Merabet L, Brignole-Baudouin F, Putterman M, Errera MH. Hidden in the Eyes—Recurrence of Systemic Hemopathies Reportedly “In Remission”: Six Cases and Review of Literature. Medicina (B Aires) 2022;58:medicina58030456. [PMID: 35334633 PMCID: PMC8950814 DOI: 10.3390/medicina58030456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open

Abstract

Background and Objectives: Secondary ocular localizations of hematological malignancies are blinding conditions with a poor prognosis, and often result in a delay in the diagnosis. Materials and Methods: We describe a series of rare cases of ocular involvement in six patients with hematological malignancies, reportedly in remission, who presented secondary ocular localizations, challenging to diagnose. Two patients had an acute lymphoblastic leukemia (ALL) and developed either a posterior scleritis or a pseudo-panuveitis with ciliary process infiltration. One patient had iris plasmacytoma and developed an anterior uveitis as a secondary presentation. Two patients had a current systemic diffuse large B-cell lymphoma (DLBCL) and were referred either for intermediate uveitis or for papilledema and vitritis with secondary retinitis. Finally, one patient with an acute myeloid leukemia (AML) presented a conjunctival localization of a myeloid sarcoma. We herein summarize the current knowledge of ophthalmologic manifestations of extramedullary hematopathies. Results: Inflammatory signs were associated with symptomatic infiltrative lesions well displayed in either the iris, the retina, the choroid, or the cavernous sinus, from the admission of the patients in the ophthalmological department. These findings suggest that patients with ALL, AML, systemic DLBCL, and myeloma can present with ophthalmic involvement, even after having been reported as in remission following an effective systemic treatment and/or allograft. Conclusions: Early detection of hidden recurrence in the eyes may permit effective treatment. Furthermore, oncologists and ophthalmologists should be aware of those rare ocular malignant locations when monitoring patient’s progression after initial treatment, and close ophthalmologic examinations should be recommended when detecting patient’s ocular symptoms after treatment.

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Affiliation(s)

Margot Denier Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
Sarah Tick Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
Romain Dubois Institut de Pathologie, CHRU de Lille, 59000 Lille, France;
Remy Dulery Service d’Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Sorbonne Université, INSERM UMRs938, 75012 Paris, France;
Andrew W. Eller Ophthalmology Service, University of Pittsburgh School of Medicine, Pittsburgh, PA 75012, USA; (A.W.E.); (G.R.B.); (D.S.G.)
Felipe Suarez Department of Hematology, Hôpital Necker-Enfants Malades, INSERM UMR 1163 et CNRS ERL 8254, Institut Imagine, Sorbonne Paris Cité, Université Paris Descartes, 149 rue de Sèvres, CEDEX 15, 75743 Paris, France; (F.S.); (A.M.)
Barbara Burroni Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, 75006 Paris, France;
Claude-Alain Maurage Centre de Recherche Jean-Pierre Aubert INSERM: U837, Université du Droit et de la Santé—Lille II, Faculté de Médecine 1, Place de Verdun, CEDEX, 59045 Lille, France; Institut de Pathologie—CHRU de Lille, 59000 Lille, France
Claire Bories France Department of Hematology, CHRU, 59000 Lille, France;
Johanna Konopacki Department of Hematology, Hôpital D’instruction des Armées Percy, 92140 Clamart, France;
Michel Puech Centre Explore Vision, 75001 Paris, France;
Didier Bouscary Department of Hematology, Faculté de Médecine Sorbonne Paris Cité, Université Paris Descartes, Hôpital Cochin, AP-HP, 75014 Paris, France;
Alberte Cantalloube Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
Emmanuel Héron Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
Ambroise Marçais Department of Hematology, Hôpital Necker-Enfants Malades, INSERM UMR 1163 et CNRS ERL 8254, Institut Imagine, Sorbonne Paris Cité, Université Paris Descartes, 149 rue de Sèvres, CEDEX 15, 75743 Paris, France; (F.S.); (A.M.)
Christophe Habas Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
Vincent Theillac Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
Chafik Keilani Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
Gabrielle R. Bonhomme Ophthalmology Service, University of Pittsburgh School of Medicine, Pittsburgh, PA 75012, USA; (A.W.E.); (G.R.B.); (D.S.G.)
Denise S. Gallagher Ophthalmology Service, University of Pittsburgh School of Medicine, Pittsburgh, PA 75012, USA; (A.W.E.); (G.R.B.); (D.S.G.)
Julien Boumendil Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
Wajed Abarah Department of Hematology, Hôpital de Meaux, 77100 Meaux, France;
Neila Sedira Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
Stéphane Bertin Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
Sylvain Choquet Department of Hematology, Hôpital Pitié-Salpêtrière, 75013 Paris, France;
José-Alain Sahel Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.) Ophthalmology Service, University of Pittsburgh School of Medicine, Pittsburgh, PA 75012, USA; (A.W.E.); (G.R.B.); (D.S.G.)
Lilia Merabet Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
Françoise Brignole-Baudouin Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.) Sorbonne Universités, 75006 Paris, France
Marc Putterman Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
Marie-Hélène Errera Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.) Ophthalmology Service, University of Pittsburgh School of Medicine, Pittsburgh, PA 75012, USA; (A.W.E.); (G.R.B.); (D.S.G.) Correspondence:

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Other (Non-CNS/Testicular) Extramedullary Localizations of Childhood Relapsed Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma-A Report from the ALL-REZ Study Group. J Clin Med 2021;10:jcm10225292. [PMID: 34830574 PMCID: PMC8621955 DOI: 10.3390/jcm10225292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open

Abstract

Children with other extramedullary relapse of acute lymphoblastic leukemia are currently poorly characterized. We aim to assess the prevalence and the clinical, therapeutic and prognostic features of extramedullary localizations other than central nervous system or testis in children with relapse of acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) treated on a relapsed ALL protocol.

PATIENTS AND METHODS

Patients with relapse of ALL and LBL, treated according to the multicentric ALL-REZ BFM trials between 1983 and 2015, were analyzed for other extramedullary relapse (OEMR) of the disease regarding clinical features, treatment and outcome. Local treatment/irradiation has been recommended on an individual basis and performed only in a minority of patients.

RESULTS

A total of 132 out of 2323 (5.6%) patients with ALL relapse presented with an OEMR (combined bone marrow relapse n = 78; isolated extramedullary relapse n = 54). Compared to the non-OEMR group, patients with OEMR had a higher rate of T-immunophenotype (p < 0.001), a higher rate of LBL (p < 0.001) and a significantly different distribution of time to relapse, i.e., more very early and late relapses compared to the non-OEMR group (p = 0.01). Ten-year probabilities of event-free survival (pEFS) and overall survival (pOS) in non-OEMR vs. OEMR were 0.38 ± 0.01 and 0.32 ± 0.04 (p = 0.0204) vs. 0.45 ± 0.01 and 0.37 ± 0.04 (p = 0.0112), respectively. OEMRs have been classified into five subgroups according to the main affected compartment: lymphatic organs (n = 32, 10y-pEFS 0.50 ± 0.09), mediastinum (n = 35, 10y-pEFS 0.11 ± 0.05), bone (n = 12, 0.17 ± 0.11), skin and glands (n = 21, 0.32 ± 0.11) and other localizations (n = 32, 0.41 ± 0.09). Patients with OEMR and T-lineage ALL/LBL showed a significantly worse 10y-pEFS (0.15 ± 0.04) than those with B-Precursor-ALL (0.49 ± 0.06, p < 0.001). Stratified into standard risk (SR) and high risk (HR) groups, pEFS and pOS of OEMR subgroups were in the expected range whereas the mediastinal subgroup had a significantly worse outcome. Subsequent relapses involved more frequently the bone marrow (58.4%) than isolated extramedullary compartments (41.7%). In multivariate Cox regression, OEMR confers an independent prognostic factor for inferior pEFS and pOS.

CONCLUSION

OEMR is adversely related to prognosis. However, the established risk classification can be applied for all subgroups except mediastinal relapses requiring treatment intensification. Generally, isolated OEMR of T-cell-origin needs an intensified treatment including allogeneic stem cell transplantation (HSCT) as a curative approach independent from time to relapse. Local therapy such as surgery and irradiation may be of benefit in selected cases. The indication needs to be clarified in further investigations.

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Mendonca TM, Lashkari HP, Kini J, Vepakomma T. Masquerade uveitis with hypopyon as a solitary feature of relapsed leukaemia in a child. BMJ Case Rep 2021;14:14/5/e240485. [PMID: 34011664 DOI: 10.1136/bcr-2020-240485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open

Kakkassery V, Coupland SE, Heindl LM. Iris lymphoma-a systematic guide for diagnosis and treatment. Surv Ophthalmol 2020;66:41-53. [PMID: 32585164 DOI: 10.1016/j.survophthal.2020.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/16/2022]

Hiraoka M, Ohguro H, Ikeda H, Furuya D, Takahashi S. Intraocular infiltration of Philadelphia chromosome-positive acute lymphoblastic leukemia diagnosed by polymerase chain reaction from the aqueous humor: A case report. Medicine (Baltimore) 2020;99:e18872. [PMID: 31977890 PMCID: PMC7004763 DOI: 10.1097/md.0000000000018872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open

Chocron IM, Morrison DG, Friedman DL, Desai NA, Donahue SP. Ophthalmic manifestations of relapsing acute childhood leukemia. J AAPOS 2015;19:284-6. [PMID: 25890837 DOI: 10.1016/j.jaapos.2015.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 02/11/2015] [Accepted: 02/13/2015] [Indexed: 11/24/2022]

Unusual sites of relapse in pre-B acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2014;36:e506-8. [PMID: 25171446 DOI: 10.1097/mph.0000000000000240] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]

Grimmett MR. Hematologic Disorders. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]

Yamamoto-Ogasawara A, Asakawa M, Yoshino K, Nagamoto T, Inoue M, Hirakata A. Anterior complications in case of recurrent acute lymphoblastic leukaemia diagnosed by biopsy of aqueous humour. Clin Exp Ophthalmol 2009;37:739-41. [PMID: 19788673 DOI: 10.1111/j.1442-9071.2009.02121.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]

Madigan WP, Raymond WR, Wroblewski KJ, Thebpatiphat N, Birdsong RH, Jaafar MS. A review of pediatric uveitis: Part I. Infectious causes and the masquerade syndromes. J Pediatr Ophthalmol Strabismus 2008;45:140-9. [PMID: 18524191 DOI: 10.3928/01913913-20080501-16] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]

Naithani R, Agrawal N, Mahapatra M, Kumar R, Choudhary VP, Singh R, Sharma DN. Isolated anterior chamber relapse in acute lymphoblastic leukemia. Ann Hematol 2006;85:889-91. [PMID: 16838162 DOI: 10.1007/s00277-006-0161-x] [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: 04/21/2006] [Accepted: 06/07/2006] [Indexed: 11/30/2022]

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Iqbal Y, Palkar V, Al-Sudairy R, Al-Omari A, Abdullah MF, Al-Debasi T. Papilledema, presenting as reversible loss of vision, in a child with acute lymphoblastic leukemia. Pediatr Blood Cancer 2005;45:72-3. [PMID: 15765529 DOI: 10.1002/pbc.20369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]

Kassam F, Gale JS, Sheidow TG. Intraocular leukemia as the primary manifestation of relapsing acute myelogenous leukemia. Can J Ophthalmol 2003;38:613-6. [PMID: 14740808 DOI: 10.1016/s0008-4182(03)80120-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]

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Patel SV, Herman DC, Anderson PM, Al-Zein NJ, Buettner H. Iris and anterior chamber involvement in acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2003;25:653-6. [PMID: 12902923 DOI: 10.1097/00043426-200308000-00015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]

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