Abstract

CHRONIC MYELOID LEUKEMIA PATIENT WITH ISOLATED CENTRAL NERVOUS SYSTEM BLAST CRISIS

Ahmed Mjali*, Yassmin Ali Abdul Kareem, Haider Hasan Jaleel Al –Shammari, Nareen Tawfeeq Abbas, Hussein Salh Abbas Alnaqeeb, Mohammed Jawad Al- Anssari and Ghufran Qahtan Abbas

ABSTRACT

The first therapeutic choice in Chronic Myeloid Leukemia (CML) is imatinib mesylate, a potent inhibitor of BCR / ABL tyrosine kinase. The blood brain barrier is poorly penetrated so that therapeutic concentrations in the cerebrospinal fluid (CSF) can hardly be achieved. Extramedullary blast crises of CML involving central nervous system (CNS) is uncommon and usually accompanies systemic relapse. We report a 42 year old male who initially had no excess blasts of the peripheral blood or bone marrow but 2 months later he presented with isolated CNS blast crisis while he is on imatinib 400mg. He was treated successfully using FLAG Ida protocol combined with dasatinib 100 mg and intrathecal chemotherapy. Patient achieved major molecular response and referred for allogeneic bone marrow transplant.

Keywords: Chronic Myeloid Leukemia (CML), Isolated CNS relapse.