Article

Isolated central nervous system relapse in childhood acute promyelocytic leukemia.

Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Journal of Pediatric Hematology/Oncology (impact factor: 1.16). 03/2008; 30(2):160-2. DOI:10.1097/MPH.0b013e318159a582 pp.160-2
Source: PubMed

ABSTRACT Central nervous system (CNS) involvement is rare in acute promyelocytic leukemia (APL). The majority of CNS relapses occur in patients with hyperleukocytosis at presentation, and the optimal management of such patients is still controversial. We describe a 13-year-old boy with APL who developed an isolated CNS relapse after first-line treatment with all-trans retinoic acid and chemotherapy. A second remission was achieved with a regimen consisting of intrathecal chemotherapy, intravenous high-dose cytarabine, and oral 6-mercaptopurine. All-trans retinoic acid was avoided owing to severe complications during initial therapy. The patient remains in molecular remission at 9 months after autologous stem cell transplant. Prognostic factors of CNS relapse in children with APL are needed to define the indications for CNS prophylaxis in this group of patients.

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Keywords

13-year-old boy
 
9 months
 
acute promyelocytic leukemia
 
All-trans retinoic acid
 
cell transplant
 
Central nervous system
 
chemotherapy
 
CNS
 
CNS prophylaxis
 
CNS relapse
 
CNS relapses
 
define
 
first-line treatment
 
initial therapy
 
intrathecal chemotherapy
 
intravenous high-dose cytarabine
 
isolated CNS relapse
 
molecular remission
 
oral 6-mercaptopurine
 
second remission