1
|
Qin LY, Geng Y, Mu JF, Wang WJ, Zhang CX, Gao YN, He JX. Central nervous system involvement in chronic lymphocytic leukemia: a case report and review of literature. J Med Case Rep 2024; 18:315. [PMID: 38982482 PMCID: PMC11234772 DOI: 10.1186/s13256-024-04639-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 06/19/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Central nervous system involvement in chronic lymphocytic leukemia rarely occurs, and there is no standard therapy for central nervous system involvement in chronic lymphocytic leukemia. This article aims to analyze the diagnosis and treatment of central nervous system involvement in chronic lymphocytic leukemia. CASE PRESENTATION It reports two cases of central nervous system involvement in chronic lymphocytic leukemia describing the clinical course, therapy, and prognosis. Case 1 is a 67-year-old Asian male patient, he experienced complications with central nervous system involvement after developing resistance to ibrutinib, bendamustine, and rituximab (BR) chemotherapies. The central nervous system lesion was controlled with high-dose methotrexate combined with pomalidomide, but Richter transformation occurred several months later. Case 2 is a 62-year-old Asian female patient, she had central nervous system involvement at initial diagnosis, and bone marrow and central nervous system lesions were controlled by ibrutinib therapy. CONCLUSION Central nervous system involvement in chronic lymphocytic leukemia is rare and can be diagnosed on the basis of clinical features, cerebrospinal fluid testing, and radiographic evaluation. Ibrutinib, pomalidomide, and other drugs that can cross the blood-brain barrier may be effective for treating central nervous system involvement in chronic lymphocytic leukemia.
Collapse
Affiliation(s)
- Li-Yuan Qin
- Department of Hematology, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
| | - Ye Geng
- Department of Hematology, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
| | - Jian-Feng Mu
- Department of Medicine, Shanxi Vocational College of Tourism, Taiyuan, 030091, China
| | - Wen-Jun Wang
- Department of Hematology, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
| | - Cai-Xia Zhang
- Department of Hematology, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
| | - Yi-Nan Gao
- Department of Hematology, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
| | - Jian-Xia He
- Department of Hematology, Shanxi Provincial People's Hospital, Taiyuan, 030012, China.
| |
Collapse
|
2
|
Wang W, Zhang Y, Zhao D, Zhang W, Zhou D. Richter's syndrome in central nervous system with MYD88L265P and CD79b mutation responded well to ibrutinib containing chemotherapy: a case report and review of the literature. Ann Hematol 2022; 101:1869-1872. [PMID: 35484253 DOI: 10.1007/s00277-022-04827-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/24/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Wei Wang
- Department of Hematology, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Yan Zhang
- Department of Hematology, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Danqing Zhao
- Department of Hematology, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China.
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| |
Collapse
|
3
|
Amado C, Duarte V, Silva Leal M, Cruz M, Ferreira G. Chronic Lymphocytic Leukaemia: Rare Involvement of the Central Nervous System. Eur J Case Rep Intern Med 2021; 8:002847. [PMID: 34912734 PMCID: PMC8667997 DOI: 10.12890/2021_002847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/05/2021] [Indexed: 11/09/2022] Open
Abstract
Involvement of the central nervous system, although uncommon, is one of the most frequent extramedullary manifestations of chronic lymphocytic leukaemia (CLL). Various conditions can lead to neurological symptoms in CLL patients and distinguishing between clinically significant CLL involvement of the CNS and other aetiologies can be challenging. The authors report the case of a 90-year-old woman with a previous diagnosis of low-risk CLL who presented to the emergency room with altered mental status. After the most frequent causes were ruled out and considering the underlying disease, CNS infiltration by clonal B-cells was hypothesised and later confirmed. Treatment was initiated, but the patient died soon afterwards.
Collapse
Affiliation(s)
- Carolina Amado
- Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Valter Duarte
- Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Mariana Silva Leal
- Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Margarida Cruz
- Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Gisela Ferreira
- Haematology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| |
Collapse
|
4
|
Tanigawa T, Sakurai M, Kato J, Mizuno K, Fujita S, Koda Y, Kikuchi T, Shimizu T, Okamoto S, Kataoka K. Successful ibrutinib treatment for central nervous system relapse of chronic lymphocytic leukemia after allogeneic hematopoietic stem cell transplantation. Ann Hematol 2021; 101:723-724. [PMID: 34235557 DOI: 10.1007/s00277-021-04586-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Tomohiko Tanigawa
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masatoshi Sakurai
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Jun Kato
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kota Mizuno
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shinya Fujita
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuya Koda
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Taku Kikuchi
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takayuki Shimizu
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Keisuke Kataoka
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| |
Collapse
|