Jo Suejung, Yoo Jae Won, Kim Seongkoo, Lee Jae Wook, Im Soo-Ah, Cho Bin, Chung Nack-Gyun
Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Front Oncol. 2023 Mar 23;13:1122714. doi: 10.3389/fonc.2023.1122714. eCollection 2023.
Most children with chronic myeloid leukemia (CML) present with the chronic phase (CML-CP) at diagnosis, exhibiting an excellent treatment response to contemporary tyrosine kinase inhibitors (TKIs). However, despite TKI therapy, patients with CML-CP may progress to blastic crisis (BC). CML-BC rarely occurs in extramedullary sites, and isolated central nervous system (CNS) BC is an extremely rare condition. It may with present various neurologic symptoms that necessitates differential diagnosis from other causes such as TKI toxicity. Information on the diagnosis and treatment of this condition is lacking, as are well-established diagnostic criteria. Here, we report a case of isolated CNS lymphoblastic crisis in a child with CML-CP who was treated with dasatinib. The patient, an 8-year-old girl, was admitted owing to visual disturbance and severe headache. We highlight the importance of a CSF study for the differential diagnosis of CNS BC in patients with CML-CP who present with common neurologic symptoms during TKI therapy.
大多数慢性髓性白血病（CML）患儿在诊断时处于慢性期（CML-CP），对当代酪氨酸激酶抑制剂（TKIs）表现出良好的治疗反应。然而，尽管接受了TKI治疗，CML-CP患者仍可能进展为急变期（BC）。CML-BC很少发生于髓外部位，孤立的中枢神经系统（CNS）BC是一种极其罕见的情况。它可能出现各种神经症状，需要与其他原因如TKI毒性进行鉴别诊断。目前缺乏关于这种情况的诊断和治疗信息，也缺乏成熟的诊断标准。在此，我们报告一例接受达沙替尼治疗的CML-CP患儿发生孤立性CNS淋巴细胞急变期的病例。该患者为一名8岁女孩，因视力障碍和严重头痛入院。我们强调了脑脊液检查对于鉴别诊断在TKI治疗期间出现常见神经症状的CML-CP患者的CNS BC的重要性。
