Significance of monitoring cerebrospinal fluid leukocyte counts in managing central nervous system disease of acute myeloid leukemia in patients presenting with intracerebral hemorrhage upon initial examination

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  • KAWAHARA Masahiro
    Department of Medicine (Division of Hematology), Shiga University of Medical Science
  • TERAMOTO Yukako
    Department of Medicine (Division of Hematology), Shiga University of Medical Science
  • ASAI Ai
    Department of Medicine (Division of Hematology), Shiga University of Medical Science
  • NAGAI Shiho
    Department of Medicine (Division of Hematology), Shiga University of Medical Science
  • IWASA Masaki
    Department of Medicine (Division of Hematology), Shiga University of Medical Science
  • FUJISHIRO Aya
    Department of Medicine (Division of Hematology), Shiga University of Medical Science
  • NISHIMURA Rie
    Department of Medicine (Division of Hematology), Shiga University of Medical Science
  • MINAMIGUCHI Hitoshi
    Department of Medicine (Division of Hematology), Shiga University of Medical Science
  • TSUJI Atsushi
    Department of Neurosurgery, Shiga University of Medical Science
  • KITO Katsuyuki
    Department of Medicine (Division of Hematology), Shiga University of Medical Science
  • ANDOH Akira
    Department of Medicine (Division of Hematology), Shiga University of Medical Science

Bibliographic Information

Other Title
  • 初診時脳内出血を伴う急性骨髄性白血病の中枢神経病変管理における髄液細胞数モニタリングの有用性
  • 症例報告 初診時脳内出血を伴う急性骨髄性白血病の中枢神経病変管理における髄液細胞数モニタリングの有用性
  • ショウレイ ホウコク ショシンジ ノウナイ シュッケツ オ トモナウ キュウセイ コツズイセイ ハッケツビョウ ノ チュウスウ シンケイ ビョウヘン カンリ ニ オケル ズイエキ サイボウスウ モニタリング ノ ユウヨウセイ

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Abstract

<p>A 17-year-old woman was urgently transported to our hospital due to consciousness disturbance. A blood examination revealed intracerebral hemorrhage, WBC 233,800/l, blasts 93%, and disseminated intravascular coagulation. The results of bone-marrow aspiration indicated acute myeloid leukemia (M2 in FAB classification) with t (7;11) (p15;p15) and the resulting chimeric gene NUP98-HOXA9 and with FLT3-ITD. Following hematoma evacuation, induction therapy was initiated and the leukocytes in the cerebrospinal fluid observed in the spinal drainage were monitored. Because they increased on days 5 and 9 after the completion of induction therapy, intrathecal chemotherapy (IT) was performed; this finally contributed to controlling AML in the central nervous system (CNS), together with the restoration of normal hematopoiesis. Subsequently, after complete molecular remission with consolidation therapies containing high-dose cytarabine, a bone-marrow transplantation with a myeloablative regimen was conducted from a 1-allele mismatched sibling donor. Finally, the patient was discharged without major sequela on day 228 after the first visit. The management of CNS disease in AML with intracerebral hemorrhage remains unclear. Our case suggests that IT at the appropriate time based on the monitored number of cerebrospinal fluid leukocytes could be useful in controlling AML in the CNS after intracerebral hemorrhage.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 59 (12), 2578-2582, 2018

    The Japanese Society of Hematology

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