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CC BY-NC-ND 4.0 · J Lab Physicians 2021; 13(02): 134-138
DOI: 10.1055/s-0041-1730752
Original Article

Isolated CNS Relapse in Acute Lymphoblastic Leukemia (ALL): An Experience from a Tertiary Care Center

Manvir Singh Tevatia
1   Department of Pathology, Command Hospital, Pune, Maharashtra, India
,
Isha Sharma
2   Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
,
Toyaja Jadhav
2   Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
,
Venkatesan Somasundaram 
3   Department of Lab Sciences and Mol Medicine, Army Hospital (R&R), Delhi, India
,
Sanjeevan Sharma
4   Department of Medicine and of Haematology, Command Hospital, Lucknow, Uttar Pradesh, India
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Abstract

Aims and Objectives In this study the various parameters of acute lymphoblastic leukemia (ALL), including the clinical features, peripheral blood and bone marrow (BM) findings, immunophenotypic and cytogenetic details in ALL cases who had isolated relapse involving the central nervous system (CNS), were studied.

Patients/Materials and Methods Duration of the study is from 2015 to 2019 in which 5 ALL cases were presented to this tertiary care center. The presenting symptoms varied from headache, fever, and distension of abdomen. These cases were either on therapy or post completion of chemotherapy. The diagnosis of CNS relapse followed after the examination of cerebrospinal fluid (CSF). Patients also underwent BM examination to rule out systemic relapse.

Results Age of patients ranged from 7 months to 42 years. There were three female patients. Two patients had isolated CNS relapse 3.5 years after completing therapy and succumbed to their illness. Two patients had t(9;22) while one patient had t(1;14) cytogenetic abnormality at diagnosis. One patient was diagnosed as T-ALL. Treatment offered was German Multicentre ALL protocol for induction along with 10 cycles of maintenance.

Conclusion The most common hematolymphoid malignancy in children namely ALL accounts for 75% of childhood leukemias. Complete remission rates reach up to 70 to 80%. CNS involvement is known to occur in these cases. CNS relapse may occur alone or with systemic relapse. Advances in therapeutic protocols along with CNS prophylaxis have drastically brought down the rates of CNS relapse. It is essential to maintain a high degree of suspicion so that these cases of isolated CNS relapse can be identified at the earliest and definitive therapy can be offered.

Keywords

acute lymphoblastic leukemia (ALL) - cerebrospinal fluid - bone marrow - central nervous system


Publication History

Article published online:
15 June 2021

© 2021. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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