Karbhari Nishika, Lara-Martinez Hugo, Hill John M
Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Department of Hematology, Kenneth Norris Jr. Comprehensive Cancer Center of USC, Los Angeles, California, USA.
Case Rep Oncol. 2022 Mar 30;15(1):345-350. doi: 10.1159/000523858. eCollection 2022 Jan-Apr.
Chronic lymphocytic leukemia (CLL) involves the proliferation of a clonal population of B cells within the bone marrow that classically spreads to the blood and lymphatic system. Central nervous system (CNS) manifestations of CLL occur rarely, and no gold standard treatment regimen has been designated to date. We report a case of CLL with CNS involvement in a 68-year-old woman who presented with a severe headache 4 years after initial diagnosis. She was started on ibrutinib, which failed to clear her CSF of malignancy. Venetoclax was then added, and this was successful in clearing her CSF. For its CNS penetration and efficacy in achieving CSF remission of CLL, we propose that venetoclax be considered as a treatment option for CLL meningitis.
慢性淋巴细胞白血病（CLL）涉及骨髓内克隆性B细胞群体的增殖，典型情况下会扩散至血液和淋巴系统。CLL的中枢神经系统（CNS）表现很少见，迄今为止尚无指定的金标准治疗方案。我们报告一例68岁女性CLL合并CNS受累的病例，该患者在初次诊断4年后出现严重头痛。她开始使用伊布替尼治疗，但未能清除其脑脊液中的恶性肿瘤细胞。随后加用维奈克拉，成功清除了她脑脊液中的肿瘤细胞。鉴于维奈克拉对CNS的穿透性以及在实现CLL脑脊液缓解方面的疗效，我们建议将维奈克拉视为CLL脑膜炎的一种治疗选择。
