Leukemia and the nervous system

Chamberlain, Marc C.

doi:10.1007/s11912-005-0028-7

Cited by 11 publications

(10 citation statements)

References 46 publications

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“…This presentation of ALL occurs in approximately 1/2 of pediatric patients and generally is attributable to leukemic infiltration of appendicular bone, periosteum, marrow spaces, and/or joints [13,15]. Compressive CNS symptoms or axial skeleton involvement at the time of ALL diagnosis is uncommon in children and adults, with a reported prevalence of 3% to 7% [2,9]. In the past, CNS involvement with ALL has been a telltale sign of disease recurrence, with up to 75% of recurrent cases presenting with new-onset compressive CNS symptoms.…”

Section: Discussion and Treatmentmentioning

confidence: 99%

“…These numbers have significantly declined in recent years owing to the addition of CNS-prophylactic chemotherapies [9]. The number of adults with ALL CNS disease today is believed to be approximately 5% to 10% [2].…”

Section: Discussion and Treatmentmentioning

confidence: 99%

“…Together, these represent approximately 90% of spinal tumors [14]. Epidural spinal cord compression secondary to leukemias of any kind are thought to occur in less than 1% of patients with epidural spinal cord compression secondary to tumors [2].…”

Section: Discussion and Treatmentmentioning

confidence: 99%

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Orthopaedic Case of the Month: A 62-year-old Woman With Neck Pain and Neurologic Findings

Papaliodis

Roberts

DiCaprio

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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A 62-year-old woman presented with 3 months of intractable neck pain with recent onset of upper extremity weakness and paresthesias. She reported no fever, weight loss, fatigue, or generalized malaise. She had subtle complaints of hand dexterity loss but said she had no problems with balance, and no bladder or bowel complaints. Analgesics and antispasmodic medications did not relieve her pain. Her medical history was significant for hypertension, hyperlipidemia, diabetes mellitus Type II, multiple sclerosis, depression, anxiety, obesity, and hypothyroidism. There was no history of antecedent trauma, previous rheumatologic phenomena, recurrent infections, or bleeding dyscrasia. There was no family history of cancer or congenital skeletal abnormalities. Review of systems was otherwise negative.On physical examination, the patient was afebrile with normal vital signs. She was oriented to person, time, and environment. The head was normocephalic and sclerae were anicteric. ROM of the neck was normal, and she had no pain with movement of her neck. She had no palpable lymphadenopathy. There was no tenderness to palpation of the posterior shoulder musculature. Cranial nerves II through XII were grossly intact; signs of hypocalcemia including Chvostek's sign and Trousseau's signs were not elicited. Abdominal examination was benign without hepatomegaly or splenomegaly. Neurologically, the patient had some mild weakness with wrist extension and finger extension on the left (C 4/5) but an otherwise normal examination with intact sensation and motor function in her lower extremities. Reflexes were brisk and symmetric. Hoffmann's sign was positive but symmetric suggesting an upper motor neuron lesion, but there was no elicitable clonus. Babinski response was plantar indicating a normal neurologic response in the lower extremities.Laboratory examination showed a white blood cell count of 7.8, hematocrit of 37.3, mean corpuscular volume (MCV) of 84, with a normal differential (54% segmented neutrophils, 9% band neutrophils, 33% lymphocytes), normal chemistries including a serum calcium of 8.9 mg/dL, and an erythrocyte sedimentation rate of 100 mm/hour.We obtained CT scans of the cervical spine (Fig. 1), head, and chest, abdomen, and pelvis, MR images of the spine (Fig. 2), and a whole-body bone scan. Imaging InterpretationThe CT scan of the cervical spine showed a prevertebral lesion extending from C7 to T2 and a permeative pattern of bone destruction within the C7 vertebra (Fig.

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Section: Discussion and Treatmentmentioning

confidence: 99%

Section: Discussion and Treatmentmentioning

confidence: 99%

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Orthopaedic Case of the Month: A 62-year-old Woman With Neck Pain and Neurologic Findings

Papaliodis

Roberts

DiCaprio

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Epidural lipomatosis is thought to be a rare entity, but it is probably underdiagnosed. Finally, the presence of an epidural hematoma, usually after a lumbar puncture on a patient with thrombocytopenia, may cause SCC [22,23].…”

Section: Differential Diagnosismentioning

confidence: 99%

Spinal cord compression in cancer patients: Review of diagnosis and treatment

Penas‐Prado

Loghin²

2008

Curr Oncol Rep

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Spinal cord compression (SCC) is a well-known complication in cancer patients, with an enormous potential impact on quality of life. In most cases, treatment is palliative, but a prompt diagnosis and immediate treatment is essential to preserving neurological function. Whereas steroids and radiation have been the mainstay of therapy for many years, the role and timing of surgery has remained controversial. However, class I evidence now exists to support the benefit of pre-irradiation surgical decompression in a carefully selected subpopulation of patients with SCC. A multidisciplinary approach is required to maximize the therapeutic and functional outcome of these patients.

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“…Cumulative neurotoxicity such as leukoencephalopathy is an important issue in patients with CNS relapse when various CNS active treatments are combined. 8,9 One of the major aims is, therefore, to achieve complete remission in the CNS, i.e. clearance of blasts from the cerebrospinal fluid, with as little cumulative toxicity as possible and to prepare the patients rapidly for SCT.…”

Section: Introductionmentioning

confidence: 99%

Liposomal cytarabine is effective and tolerable in the treatment of central nervous system relapse of acute lymphoblastic leukemia and very aggressive lymphoma

Gökbuget

Hartog²,

Bassan³

et al. 2010

Haematologica

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BackgroundTreatment of central nervous system relapse in adult acute lymphoblastic leukemia is a challenge and outcome is poor. Liposomal cytarabine has a prolonged half-life and, given intrathecally, has produced high response rates in patients with central nervous system relapse of non-Hodgkin's lymphoma. The aim of this study was to evaluate the efficacy and tolerability of liposomal cytarabine in central nervous system relapse of acute lymphoblastic leukemia or Burkitt's lymphoma/leukemia. Design and MethodsLiposomal cytarabine (50 mg) was given intrathecally together with systemic or intrathecal dexamethasone once every 2 weeks in a phase II European trial. The primary end-point, cytological response in the cerebrospinal fluid after one or two cycles, was evaluated at the time of next treatment. ResultsNineteen heavily pretreated patients (median age, 53 years; range 24-76 years) were evaluable: 14 with acute lymphoblastic leukemia and 5 with Burkitt's lymphoma/leukemia). Complete cytological remission as best response after two cycles of liposomal cytarabine was confirmed in 74% of the patients: 86% of those with acute lymphoblastic leukemia and 40% of those with Burkitt's lymphoma/leukemia). Nine of the 14 patients who achieved complete remission relapsed after a median of 7 months. The median overall survival was 11 months. Adverse events were observed in 89% of the patients (57% of cycles). Grade III-IV events with potential correlation to liposomal cytarabine occurred in 32% of the patients. The most frequent adverse event was headache. One patient developed severe neurological complications with loss of vision and a conus syndrome. ConclusionsOverall, liposomal cytarabine showed excellent antileukemic activity. Toxicity was acceptable but appeared to increase with the number of cycles. Future evaluation in prophylaxis is of interest (ClinicalTrials.gov Identifier:NCT00199108) Key words: liposomal cytarabine, acute lymphoblastic leukemia, aggressive lymphoma, CNS relapse, adults.Citation: Gökbuget N, Hartog C-M, Bassan R, Derigs H-G, Dombret H, Greil R, Hernández-Rivas J-M, Huguet F, Intermesoli T, Jourdan E, Junghanss C, Leimer L, Moreno M-J, Reichle A, Ribera J, Schmid M, Serve H, Stelljes M, Stuhlmann R, and Hoelzer D

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Leukemia and the nervous system

Cited by 11 publications

References 46 publications

Orthopaedic Case of the Month: A 62-year-old Woman With Neck Pain and Neurologic Findings

Orthopaedic Case of the Month: A 62-year-old Woman With Neck Pain and Neurologic Findings

Spinal cord compression in cancer patients: Review of diagnosis and treatment

Liposomal cytarabine is effective and tolerable in the treatment of central nervous system relapse of acute lymphoblastic leukemia and very aggressive lymphoma

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