Korean J Med.  2011 Feb;80(2):231-237.

Central Nervous System Relapse in Patients with Acute Promyelocytic Leukemia Treated with All-trans Retinoic Acid

• Kim EO
• Gil SH
• Choi JK
• Lee HJ
• Kim HJ
• Lee JW
• Min WS

Abstract

Acute promyelocytic leukemia (APL) is distinguished from other subtypes of acute myeloid leukemia (AML) by its distinctive morphology, specific chromosomal abnormality, coagulopathy, and unique response to treatment with all-trans retinoic acid (ATRA). Central nervous system (CNS) involvement is rare in APL. Most CNS relapses occur in patients with hyperleukocytosis at initial presentation, and the optimal management of such patients is still controversial. We report five patients with APL who had CNS relapse with or without evidence of cytological and molecular disease of the bone marrow after ATRA treatment. Brain magnetic resonance imaging revealed leptomeningeal infiltration and cerebrospinal fluid examination showed the presence of promyelocytes. Patients were treated with a combination of systemic chemotherapy and radiotherapy with or without intrathecal chemotherapy, and most were subsequently treated with arsenic trioxide (ATO) as maintenance therapy. Among these patients, one received allogeneic stem cell transplantation in second complete remission.

Keyword

Acute promyelocytic leukemia; Central nervous system; Relapse; Arsenic trioxide

MeSH Terms

Arsenic
Arsenicals
Bone Marrow
Brain
Central Nervous System
Chromosome Aberrations
Granulocyte Precursor Cells
Humans
Leukemia, Myeloid, Acute
Leukemia, Promyelocytic, Acute
Magnetic Resonance Imaging
Oxides
Recurrence
Stem Cell Transplantation
Tretinoin
Arsenic
Arsenicals
Oxides
Tretinoin