An Unusual Presentation of Chronic Myelogenous Leukemia: A Review of Isolated Central Nervous System Relapse
Many effective therapeutic options are available for patients with chronic myelogenous leukemia (CML). Imatinib, a first-generation tyrosine kinase inhibitor (TKI), is one of several options for patients who present with CML, whether in chronic phase, accelerated phase, or blast crisis. Although CML is very responsive to the selective TKIs, with response rates in chronic phase of greater than 90%, unusual presentations have been documented. Response rates for patients with CML in accelerated phase and blast crisis are notably lower to both first- and second-generation TKIs. This report presents a recent case of a young woman with newly diagnosed CML who presented with an accelerated phase isolated central nervous system (CNS) relapse after standard imatinib therapy, who initially experienced a complete hematologic response. Further treatment options, and monitoring of disease response, are discussed. Aggressive strategies, such as intrathecal chemotherapy, change in tyrosine kinase inhibitor to one with increased CNS penetration, and consideration of allogenic stem cell transplantation, are potential therapeutic modalities. Prophylaxis of the CNS in patients deemed at risk is an area requiring further study.
This activity has been designated to meet the educational needs of physicians and nurses involved in the management of patients with cancer.
Upon completion of this activity, participants will be able to:
- Compare and contrast response rates to TKI therapy for patients who present with CML in chronic phase, accelerated phase or blast crisis
- Discuss treatment strategies and monitoring of response to isolated CNS disease in patients with CML
Scott M. Lindhorst, MD
Duke University Medical Center
Durham, North Carolina
Richard D. Lopez, MD
University of Alabama at Birmingham Medical Center and Comprehensive Cancer Center
Ronald D. Sanders, MD
- 1.00 Participation
- 1.00 Nurse
- 1.00 Physician