Kishimoto N, Shimada H, Adachi M, Shiomura T, Kinoshita M, Harada K
Department of Hematology, Shizuoka General Hospital.
Rinsho Ketsueki. 1994 Sep;35(9):876-80.
A 38-year-old woman with acute monoblastic leukemia developed severe continuous pain in the left arm while she was in hematologic remission following both systemic and intrathecal chemotherapy. A nerve conduction study (NCS) showed marked decrease of amplitude in the left ulnar nerve, consistent with infiltration of leukemic cells. The pain in the arm was reduced by irradiation to the left brachial plexus, but right facial nerve palsy occurred. No improvement was achieved by systemic and intrathecal chemotherapy plus irradiation to the whole brain and right parotid. After sometime, she complained of pains in the legs and right foot drop. NCS showed amplitude decrease in bilateral peroneal nerve. Throughout the course, bone marrow remained in complete remission, and no signs of meningeal leukemia were obtained. A treatment with high dose Ara-C appeared to be effective for the pain in the legs. The foot drop, however, persisted and peripheral neuropathy progressed even after high dose Ara-C therapy. Peripheral nerve involvement in acute leukemia appears to be rare, and even more so in case of hematologic remission. The blood-nerve barrier may allow some malignant cells to escape from cytotoxic agents. Therefore, irradiation or high dose Ara-C therapy would seem to be rational approaches to the problem.
一名38岁的急性单核细胞白血病女性患者，在接受全身及鞘内化疗后处于血液学缓解期时，左臂出现严重的持续性疼痛。神经传导研究（NCS）显示左侧尺神经振幅明显降低，符合白血病细胞浸润。通过对左臂丛神经进行放射治疗，手臂疼痛减轻，但出现了右侧面神经麻痹。全身及鞘内化疗联合全脑及右腮腺放射治疗均未取得改善。一段时间后，她抱怨腿部疼痛和右足下垂。NCS显示双侧腓总神经振幅降低。在整个病程中，骨髓一直处于完全缓解状态，未发现脑膜白血病迹象。高剂量阿糖胞苷治疗似乎对腿部疼痛有效。然而，即使在高剂量阿糖胞苷治疗后，足下垂仍持续存在，周围神经病变仍在进展。急性白血病累及周围神经似乎很少见，在血液学缓解的情况下更是如此。血神经屏障可能使一些恶性细胞逃避细胞毒性药物的作用。因此，放射治疗或高剂量阿糖胞苷治疗似乎是解决该问题的合理方法。
