Spectrum of Neurologic Complications in Chronic Lymphocytic Leukemia

Silva, Rodrigo Lopes da

doi:10.1016/j.clml.2011.10.005

Cited by 35 publications

(45 citation statements)

References 150 publications

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“…Although a consistent rate of CNSi has been reported in autopsy studies of CLL patients (Reske-Nielsen et al, 1974;Bojsen-Møller & Nielsen, 1983;Barcos et al, 1987), only a few clinical cases of symptomatic CNS infiltration by CLL have been reported (Cramer et al, 1996;Lopes da Silva, 2012;Moazzam et al, 2012;Strati et al, 2016).…”

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confidence: 99%

Management of central nervous system involvement in chronic lymphocytic leukaemia: a retrospective cohort of 30 patients

et al. 2016

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SummaryCentral nervous system involvement (CNSi) is a rare and poorly reported complication of chronic lymphocytic leukaemia (CLL). Establishing cause and effect between the CLL and the neurological symptoms remains challenging. We have analysed a retrospective cohort of 30 CLL patients with CNSi, documented by lymphocytic infiltration either by flow cytometry of the cerebrospinal fluid (CSF; n = 29) or CNS biopsy (n = 1). Neurological symptoms were heterogeneous. At the time of CNSi, less than half of the patients had a progressive CLL and 20 had never been treated for CLL. Initial treatment with fludarabine-based immuno-chemotherapy, with or without intra-CSF therapy, led to durable response in eight out of nine untreated patients. In contrast, 50% patients receiving various prior treatments needed additional therapy within a median of 4 months (1-16). Ibrutinib led to complete response in 4/4 heavily pre-treated patients. From CNSi, 5-year overall survival was 72% and 48% for treatment-na€ ıve and previously treated patients respectively (P = 0Á06); 5-year progression-free survival (PFS) was 43% and 0% (P = 0Á125). 17p deletion was significantly associated with poor PFS (P = 0Á006). CNSi may be the only sign of progression of CLL and should be considered an initiation criterion of systemic treatment. Prognosis seemed to be related to CLL characteristics rather than to CNSi itself.

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confidence: 99%

Management of central nervous system involvement in chronic lymphocytic leukaemia: a retrospective cohort of 30 patients

et al. 2016

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“…In 27.9% of patients, neurological symptoms were present at diagnosis of CLL. Counterintuitively, previous studies did not show a clear correlation between the occurrence of CNS localisation and CLL Rai stage at time of onset [12, 13]. This highlights the necessity of incorporating CNS localisation in the differential diagnosis in any patient with CLL and neurological symptoms, irrespectively of time of diagnosis or disease activity.…”

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confidence: 84%

Central nervous system localisation of chronic lymphocytic leukaemia, description of two very distinct cases and a review of the literature

et al. 2018

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Central nervous system (CNS) localisation of chronic lymphocytic leukaemia (CLL) can induce various neurological symptoms. Unfamiliarity with this manifestation causes diagnostic delay. We present two cases of leptomeningeal CLL. These cases and our literature review emphasise that CNS localisation of CLL should be considered in patients with any neurological symptom, irrespectively of the stage and systemic activity of CLL.Electronic supplementary materialThe online version of this article (10.1007/s00277-018-3329-2) contains supplementary material, which is available to authorized users.

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“…PML in the context of CLL treatment-naïve patients has lost preponderance, and since 1990, 90% of the cases of PML among patients with CLL occurred in those treated with purine analogues, especially fludarabine and cladribine 2. With respect to alemtuzumab, after a review of the medical literature, we found reference to four published cases of PML under this monoclonal antibody treatment (three in patients with CLL and 1 in a lung transplant recipient) 5–7.…”

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confidence: 99%

Progressive multifocal leukoencephalopathy in a patient with chronic lymphocytic leukaemia treated with alemtuzumab

et al. 2014

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A 69-year-old Caucasian woman with a 15-year history of refractory chronic lymphocytic B-cell leukaemia (CLL), treated with alemtuzumab in the past 10 months presented with a subacute right foot drop. Initial evaluation with a brain CT scan, lumbosacral MRI, nerve conduction studies and LP was negative. In the following months, progressive right hemibody weakness and dysarthria developed. Brain MRI showed a bilateral parasagittal frontal lesion. Alemtuzumab treatment was withdrawn. Progressive multifocal leukoencephalopathy (PML) was confirmed by PCR. Attempted antiviral therapies proved fruitless. Inexorable clinical deterioration ensued and the patient passed away 10 months after the presentation. This case report intends to call attention for PML as a potential fatal complication of severe immunosuppression, including the possible role of new monoclonal antibodies (such as alemtuzumab) in its pathogenesis.

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Spectrum of Neurologic Complications in Chronic Lymphocytic Leukemia

Cited by 35 publications

References 150 publications

Management of central nervous system involvement in chronic lymphocytic leukaemia: a retrospective cohort of 30 patients

Management of central nervous system involvement in chronic lymphocytic leukaemia: a retrospective cohort of 30 patients

Central nervous system localisation of chronic lymphocytic leukaemia, description of two very distinct cases and a review of the literature

Progressive multifocal leukoencephalopathy in a patient with chronic lymphocytic leukaemia treated with alemtuzumab

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