TITLE:
Philadelphie chromosome—Positive de novo acute myeloid leukemia. Isolated meningeal relapse in a patient treated with imatinib mesylate
AUTHORS:
I. Ben Amor, S. Hdiji Mseddi, O. Kassar, S. Hdiji Mnif, Ines Jdidi, M. Mdhaffar, L. Kammoun, H. Bellaaj, A. Saad, M. Elloumi
KEYWORDS:
Acute Myeloid Leukemia; Philadelphie Chromosome; Meningeal Relapse
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.2 No.2,
May
24,
2013
ABSTRACT:
Acute myeloid leukemia philadelphie positive (Ph+ AML) is
a rare aggressive acute leukemia with poor prognosis. We report a patient with
ph positive AML (FAB5), the transcript bcr/abl was not performed at diagnosis.
She achieved complete remission after
conventional induction chemotherapy. The consolidation therapy was based on Imatinib only due to infectious complications. She was in complete
hematologic and cytogenetic remission for 19 months, and after she exhibited an
isolated meningeal relapse. A second remission was achieved with intrathecal
chemotherapy and cranial irradiation. Imatinib was switched to second
generation Tyrosine kinase Inhibitor which had better diffusion into
cerebrospinal fluid. She is in complete hematologic, cytogenetic and
meningeal remission after 14 months of treatment. Imatinib monotherapy affords
insufficient protection from CNS relapse. Second generation Tyrosine kinase Inhibitor seems to have better efficiency. Ph+
AML with monoblastic differentiation should be considered, like Ph+ ALL,
at high risk of meningeal leukemia and should receive central nervous system
prophylaxis.