Central Nervous System Double Relapse of Acute Promyelocytic Leukemia and Acute Myelomonocytic Leukemia

Laura M Stanko,Nikolaos Papadantonakis,Fady M Mikhail,Vishnu Reddy

doi:10.1155/2019/4907352

Laura M Stanko, Nikolaos Papadantonakis + Show 2 more

Open Access

https://doi.org/10.1155/2019/4907352

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Abstract

Relapse of acute promyelocytic leukemia (APL) and non-M3-acute myeloid leukemia in the central nervous system (CNS) are rare events. Here, we describe a case of simultaneous relapses of APL and acute myelomonocytic leukemia on the CNS of a patient after allogeneic bone marrow transplant. This extremely unusual case highlights the difficulties that CNS leukemia relapses pose in the post-transplant setting.

Highlights

Central nervous system (CNS) recurrence in adults with either acute promyelocytic leukemia (APL) or other subtypes of acute myeloid leukemia (AML) is uncommon, with previous studies reporting occurrences of 3–5% in APL and 1–2.5% in AML [1, 2]
We present here a case of simultaneous, double relapse, of acute myelomonocytic leukemia (AMML) and APL in the CNS of a patient with concurrent molecular relapse of APL in the bone marrow (BM)
A BM biopsy performed on day 35 was without morphological evidence of APL, but FISH analysis revealed 5.5% of interphase cells were still positive for the PML/RARA fusion

Summary

Introduction

Central nervous system (CNS) recurrence in adults with either acute promyelocytic leukemia (APL) or other subtypes of acute myeloid leukemia (AML) is uncommon, with previous studies reporting occurrences of 3–5% in APL and 1–2.5% in AML [1, 2]. These recurrences are typically associated with poor prognosis, and there is no consensus as to optimal treatment regimens [2, 3]. We present here a case of simultaneous, double relapse, of acute myelomonocytic leukemia (AMML) and APL in the CNS of a patient with concurrent molecular relapse of APL in the bone marrow (BM)

Case Presentation

Findings

Discussion