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Central Nervous System Involvement by Small Lymphocytic Lymphoma after a Myxoma-Related Embolic Event. Case Rep Hematol 2019; 2019:1825491. [PMID: 31827948 PMCID: PMC6881765 DOI: 10.1155/2019/1825491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/05/2019] [Accepted: 10/23/2019] [Indexed: 12/22/2022] Open
Abstract
Involvement of the central nervous system by chronic lymphocytic leukemia/small lymphocytic lymphoma is exceedingly rare, and currently no risk factors have been described. We report the case of a patient with concomitant chronic lymphocytic leukemia/small lymphocytic lymphoma and an embolic cerebrovascular accident related to a cardiac myxoma, who developed parenchymal central nervous system involvement of lymphoma on the ischemic bed. The patient was successfully treated with a high-dose fludarabine-based chemotherapy regimen, achieving a sustained remission. We propose that embolic breakage of the blood-brain barrier may be a major risk factor in producing central nervous system involvement. We also propose that a high-dose fludarabine-based chemotherapy regimen may be adequate to achieve a better CNS penetration and improved outcomes.
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2
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Naydenov AV, Taylor LP. Leptomeningeal Carcinomatosis in Chronic Lymphocytic Leukemia: A Case Report and Review of the Literature. Oncologist 2019; 24:1237-1245. [PMID: 30842245 DOI: 10.1634/theoncologist.2018-0619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 01/25/2019] [Indexed: 11/17/2022] Open
Abstract
Leptomeningeal disease is a rare complication of chronic lymphocytic leukemia (CLL). We report a case of leptomeningeal disease in CLL with a complete clinical response and clearance of cerebral spinal fluid (CSF) after treatment with ibrutinib and intrathecal rituximab. In a comprehensive review of the published literature since 1976, we found 136 cases of CLL with leptomeningeal spread. We found that leptomeningeal disease in patients with CLL responds favorably to treatment in most cases and is associated with longer overall survival than is expected for other cancers. Clearance of CSF is associated with improved survival. Treatment with rituximab and ibrutinib is more frequently associated with complete response compared with older agents. IMPLICATIONS FOR PRACTICE: The incidence of leptomeningeal CLL is more common than previously described and can be recognized by attention to certain symptoms and signs. This case presentation and literature review reveals that, in many cases, leptomeningeal lymphomatosis is reversible with the use of rituximab and ibrutinib. The authors show a survival benefit associated with treating to cerebral spinal fluid (CSF) clearance by cytology and compare outcomes with various treatment strategies, focusing on novel agents. Now that there is effective therapy for leptomeningeal lymphoma in CLL, the importance for oncologists to recognize this neurologic complication has become clear.
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MESH Headings
- Adenine/analogs & derivatives
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/cerebrospinal fluid
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Male
- Meningeal Carcinomatosis/cerebrospinal fluid
- Meningeal Carcinomatosis/complications
- Meningeal Carcinomatosis/diagnosis
- Meningeal Carcinomatosis/drug therapy
- Middle Aged
- Piperidines
- Pyrazoles/administration & dosage
- Pyrimidines/administration & dosage
- Remission Induction
- Rituximab/administration & dosage
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Affiliation(s)
- Alipi V Naydenov
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Lynne P Taylor
- Department of Neurology, University of Washington, Seattle, Washington, USA
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
- Alvord Brain Tumor Center, University of Washington, Seattle, Washington, USA
- Seattle Cancer Care Alliance, Seattle, Washington, USA
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3
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Bing-Neel Syndrome: Illustrative Cases and Comprehensive Review of the Literature. Mediterr J Hematol Infect Dis 2017; 9:e2017061. [PMID: 29181138 PMCID: PMC5667529 DOI: 10.4084/mjhid.2017.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/17/2017] [Indexed: 12/20/2022] Open
Abstract
The Bing-Neel syndrome is a rare neurological complication of Waldenström’s Macroglobulinemia which results from a direct involvement of central nervous system by malignant lymphoplasmacytic cells. The clinical suspicion of Bing-Neel syndrome may be overlooked because neurologic symptoms are heterogeneous, nonspecific and sometimes underhand. A definitive diagnosis of Bing-Neel syndrome can be confidently made using brain and spinal cord magnetic resonance imaging as well as histopathology and/or cerebrospinal fluid analysis to confirm the neoplastic infiltration of central nervous system. The detection in the cerebrospinal fluid of patients with Bing-Neel syndrome of the MYD88 (L265P) somatic mutation, which is highly recurrent in Waldenström’s Macroglobulinemia, proved useful for the diagnosis and monitoring of central nervous system involvement. Despite recommendations recently published, there is still no clear consensus on treatment of Bing-Neel syndrome, which includes systemic immunochemotherapy, intrathecal chemotherapy and brain irradiation as possible options. Ibrutinib, a Bruton kinase inhibitor approved for Waldenström’s Macroglobulinemia, has been recently added to the therapeutic armamentarium of Bing-Neel syndrome due to its ability to pass the blood-brain barrier. However, prospective clinical trials are eagerly awaited with the aim to define the optimal treatment strategy. Here we describe four illustrative cases of Bing-Neel syndrome diagnosed and treated at our Institution and review the literature on this topic.
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4
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Wanquet A, Birsen R, Bonnet C, Boubaya M, Choquet S, Dupuis J, Lepretre S, Re D, Fahri J, Michallet AS, Ysebaert L, Lemal R, Lamy T, Delarue R, Troussard X, Cymbalista F, Levy V, Dietrich PY, Leblond V, Aurran-Schleinitz T. Management of central nervous system involvement in chronic lymphocytic leukaemia: a retrospective cohort of 30 patients. Br J Haematol 2016; 176:37-49. [PMID: 27858991 DOI: 10.1111/bjh.14387] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 07/20/2016] [Indexed: 01/01/2023]
Abstract
Central nervous system involvement (CNSi) is a rare and poorly reported complication of chronic lymphocytic leukaemia (CLL). Establishing cause and effect between the CLL and the neurological symptoms remains challenging. We have analysed a retrospective cohort of 30 CLL patients with CNSi, documented by lymphocytic infiltration either by flow cytometry of the cerebrospinal fluid (CSF; n = 29) or CNS biopsy (n = 1). Neurological symptoms were heterogeneous. At the time of CNSi, less than half of the patients had a progressive CLL and 20 had never been treated for CLL. Initial treatment with fludarabine-based immuno-chemotherapy, with or without intra-CSF therapy, led to durable response in eight out of nine untreated patients. In contrast, 50% patients receiving various prior treatments needed additional therapy within a median of 4 months (1-16). Ibrutinib led to complete response in 4/4 heavily pre-treated patients. From CNSi, 5-year overall survival was 72% and 48% for treatment-naïve and previously treated patients respectively (P = 0·06); 5-year progression-free survival (PFS) was 43% and 0% (P = 0·125). 17p deletion was significantly associated with poor PFS (P = 0·006). CNSi may be the only sign of progression of CLL and should be considered an initiation criterion of systemic treatment. Prognosis seemed to be related to CLL characteristics rather than to CNSi itself.
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Affiliation(s)
- Anne Wanquet
- Department of Haematology, Institut Paoli-Calmettes, Marseille, France
| | - Rudy Birsen
- Department of Haematology, Hôpital La Pitié-Salpêtrière, AP-HP, Paris, France
| | - Charlotte Bonnet
- Department of Neurological Surgery, CHU Bordeaux, Bordeaux, France
| | | | - Sylvain Choquet
- Department of Haematology, Hôpital La Pitié-Salpêtrière, AP-HP, Paris, France
| | - Jehan Dupuis
- Lymphoid Malignancies Unit, Henri Mondor University Hospital, AP-HP, Créteil, France
| | | | - Daniel Re
- Department of Medicine 3, Centre Hospitalier, Antibes, France
| | | | | | | | - Richard Lemal
- Service de thérapie cellulaire et d'hématologie clinique adulte CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Richard Delarue
- Department of Haematology, Hôpital Necker, AP-HP, Paris, France
| | | | | | - Vincent Levy
- URC/CRC, Hôpital Avicenne, AP-HP, Bobigny, France
| | | | - Veronique Leblond
- Department of Haematology, Hôpital La Pitié-Salpêtrière, AP-HP, Paris, France
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5
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Castillo JJ, D’Sa S, Lunn MP, Minnema MC, Tedeschi A, Lansigan F, Palomba ML, Varettoni M, Garcia-Sanz R, Nayak L, Lee EQ, Rinne ML, Norden AD, Ghobrial IM, Treon SP. Central nervous system involvement by Waldenström macroglobulinaemia (Bing-Neel syndrome): a multi-institutional retrospective study. Br J Haematol 2016; 172:709-15. [PMID: 26686858 PMCID: PMC5480405 DOI: 10.1111/bjh.13883] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/30/2015] [Indexed: 02/06/2023]
Abstract
Bing-Neel syndrome (BNS) is a rare complication seen in patients with Waldenström macroglobulinaemia (WM), in which lymphoplasmacytic lymphoma cells colonize the central nervous system. In this retrospective multi-centre study, we present the clinicopathological features, imaging findings, therapy, response and outcomes of 34 patients with BNS. The median time from WM diagnosis to BNS diagnosis was 3 years, 15% of patients were diagnosed with BNS at the time of WM diagnosis, and 22% of patients developed BNS when responding to active treatment for WM. Patients with BNS presented with variable clinical features including limb motor deficits, change in mental status and cranial nerve palsies. The diagnosis was made using a combination of cerebrospinal fluid cytology, flow cytometry and detection of the MYD88 L265 mutation, and magnetic resonance imaging. The estimated 3-year overall survival rate was 59%. Of the survivors, 40% have evidence of pathological and/or radiological persistence of disease. Age older than 65 years, platelet count lower than 100 × 10(9) /l, and treatment for WM prior to BNS diagnosis were associated with worse outcome. Exposure to rituximab for treatment of BNS was associated with a better outcome. Multi-institutional collaboration is warranted to improve treatment and outcomes in patients with BNS.
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Affiliation(s)
- Jorge J. Castillo
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | - M. Lia Palomba
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Lakshmi Nayak
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Eudocia Q. Lee
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Mikael L. Rinne
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Andrew D. Norden
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Irene M. Ghobrial
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Steven P. Treon
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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6
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Strati P, Uhm JH, Kaufmann TJ, Nabhan C, Parikh SA, Hanson CA, Chaffee KG, Call TG, Shanafelt TD. Prevalence and characteristics of central nervous system involvement by chronic lymphocytic leukemia. Haematologica 2016; 101:458-65. [PMID: 26819053 DOI: 10.3324/haematol.2015.136556] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 01/22/2016] [Indexed: 11/09/2022] Open
Abstract
Abroad array of conditions can lead to neurological symptoms in chronic lymphocytic leukemia patients and distinguishing between clinically significant involvement of the central nervous system by chronic lymphocytic leukemia and symptoms due to other etiologies can be challenging. Between January 1999 and November 2014, 172 (4%) of the 4174 patients with chronic lymphocytic leukemia followed at our center had a magnetic resonance imaging of the central nervous system and/or a lumbar puncture to evaluate neurological symptoms. After comprehensive evaluation, the etiology of neurological symptoms was: central nervous system chronic lymphocytic leukemia in 18 patients (10% evaluated by imaging and/or lumbar puncture, 0.4% overall cohort); central nervous system Richter Syndrome in 15 (9% evaluated, 0.3% overall); infection in 40 (23% evaluated, 1% overall); autoimmune/inflammatory conditions in 28 (16% evaluated, 0.7% overall); other cancer in 8 (5% evaluated, 0.2% overall); and another etiology in 63 (37% evaluated, 1.5% overall). Although the sensitivity of cerebrospinal fluid analysis to detect central nervous system disease was 89%, the specificity was only 42% due to the frequent presence of leukemic cells in the cerebrospinal fluid in other conditions. No parameter on cerebrospinal fluid analysis (e.g. total nucleated cells, total lymphocyte count, chronic lymphocytic leukemia cell percentage) were able to offer a reliable discrimination between patients whose neurological symptoms were due to clinically significant central nervous system involvement by chronic lymphocytic leukemia and another etiology. Median overall survival among patients with clinically significant central nervous system chronic lymphocytic leukemia and Richter syndrome was 12 and 11 months, respectively. In conclusion, clinically significant central nervous system involvement by chronic lymphocytic leukemia is a rare condition, and neurological symptoms in patients with chronic lymphocytic leukemia are due to other etiologies in approximately 80% of cases. Analysis of the cerebrospinal fluid has high sensitivity but limited specificity to distinguish clinically significant chronic lymphocytic leukemia involvement from other etiologies.
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Affiliation(s)
- Paolo Strati
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Joon H Uhm
- Mayo Clinic College of Medicine, Rochester, MN, USA
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7
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de Souza SL, Santiago F, Ribeiro-Carvalho MDM, Arnóbio A, Soares AR, Ornellas MH. Leptomeningeal involvement in B-cell chronic lymphocytic leukemia: a case report and review of the literature. BMC Res Notes 2014; 7:645. [PMID: 25218117 PMCID: PMC4246480 DOI: 10.1186/1756-0500-7-645] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/08/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Central nervous system involvement is considered a rare complication of chronic lymphocytic leukemia, and so there is the risk of being overlooked. CASE PRESENTATION We report a case of central nervous system involvement in a 75-year-old mulatto woman with chronic lymphocytic leukemia after 5 years of follow-up and a literature review on the subject. The clinical course, treatment and outcome are described. A systematic, meticulous and comprehensive analysis of existing publications regarding chronic lymphocytic leukemia with central nervous system involvement was performed. CONCLUSION We concluded that central nervous system involvement of chronic lymphocytic leukemia is probably not associated with any evident risk factors. Diagnostic approach differs by institutions but often includes imaging, morphology and flow cytometry. Resolution of central nervous system symptoms can usually be accomplished with intrathecal chemotherapy or irradiation followed by systemic treatment. The recognition of this entity by clinicians could lead to early detection and treatment, resulting in better outcomes in this rare complication.
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Affiliation(s)
- Simone Lima de Souza
- />Departamento de Patologia, Faculdade de Ciências Medicas, Programa de Pós Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, 444/4° andar, Vila Isabel, Rio de Janeiro Brazil
| | - Fábio Santiago
- />Departamento de Patologia, Faculdade de Ciências Medicas, Programa de Pós Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, 444/4° andar, Vila Isabel, Rio de Janeiro Brazil
| | - Marilza de Moura Ribeiro-Carvalho
- />Departamento de Patologia, Faculdade de Ciências Medicas, Programa de Pós Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, 444/4° andar, Vila Isabel, Rio de Janeiro Brazil
| | - Adriano Arnóbio
- />Departamento de Patologia, Faculdade de Ciências Medicas, Programa de Pós Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, 444/4° andar, Vila Isabel, Rio de Janeiro Brazil
| | - Andréa Ribeiro Soares
- />Serviço de Hematologia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Helena Ornellas
- />Departamento de Patologia, Faculdade de Ciências Medicas, Programa de Pós Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, 444/4° andar, Vila Isabel, Rio de Janeiro Brazil
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8
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Göçmen S, Kutlay M, Erikçi A, Atabey C, Sayan O, Haholu A. Central nervous system involvement of T-cell prolymphocytic leukemia diagnosed with stereotactic brain biopsy: case report. Turk J Haematol 2014; 31:75-8. [PMID: 24764733 PMCID: PMC3996638 DOI: 10.4274/tjh.2012.0028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 11/06/2012] [Indexed: 12/01/2022] Open
Abstract
Prolymphocytic leukemia (PLL) is a generalized malignancy of the lymphoid tissue characterized by the accumulation of monoclonal lymphocytes, usually of B cell type. Involvement of the central nervous system (CNS) is an extremely rare complication of T-cell prolymphocytic leukemia (T-PLL). We describe a case of T-PLL presenting with symptomatic infiltration of the brain that was histopathologically proven by stereotactic brain biopsy. We emphasize the importance of rapid diagnosis and immediate treatment for patients presenting with CNS involvement and a history of leukemia or lymphoma.
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Affiliation(s)
- Selçuk Göçmen
- Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Department of Neurosurgery, İstanbul, Turkey
| | - Murat Kutlay
- Gülhane Military Medical Academy, Department of Neurosurgery, Ankara, Turkey
| | - Alev Erikçi
- Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Department of Hematology, İstanbul, Turkey
| | - Cem Atabey
- Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Department of Neurosurgery, İstanbul, Turkey
| | - Ozkan Sayan
- Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Department of Hematology, İstanbul, Turkey
| | - Aptullah Haholu
- Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Department of Pathology, İstanbul, Turkey
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9
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Ratterman M, Kruczek K, Sulo S, Shanafelt TD, Kay NE, Nabhan C. Extramedullary chronic lymphocytic leukemia: systematic analysis of cases reported between 1975 and 2012. Leuk Res 2013; 38:299-303. [PMID: 24064196 DOI: 10.1016/j.leukres.2013.08.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/16/2013] [Accepted: 08/17/2013] [Indexed: 11/26/2022]
Abstract
The prognostic significance of extra-medullary chronic lymphocytic leukemia (EM-CLL) is unknown. We conducted a Medline database systematic search analyzing English language articles published between 1975 and 2012 identifying 192 cases. Patients with EM-CLL were more commonly treated than not (p < .001). Skin and central nervous system (CNS) were the most commonly reported sites of organ involvement. Survival after diagnosis of EM-CLL appeared to depend on the site of EM involvement. Prospective evaluation and further studies of EM-CLL are warranted.
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Affiliation(s)
- Megan Ratterman
- Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, IL, United States
| | - Kimberly Kruczek
- Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, IL, United States
| | - Suela Sulo
- James R. & Helen D. Russell Institute for Research & Innovation, Advocate Lutheran General Hospital, Park Ridge, IL, United States
| | - Tait D Shanafelt
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Neil E Kay
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Chadi Nabhan
- Department of Medicine, Section of Hematology and Oncology, The University of Chicago, Chicago, IL, United States.
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10
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Gonsalves WI, Zent CS, Pulido JS, Patnaik MM. Visual Loss in Early-Stage Chronic Lymphocytic Leukemia. J Clin Oncol 2013; 31:e280-2. [DOI: 10.1200/jco.2012.46.7431] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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Chan KL, McKelvie P, Firkin F, Bazargan A, Tam CS. Chronic lymphocytic leukemia presenting as an intracranial epidural mass in a patient with myeloproliferative neoplasm associated with JAK2 V617F mutation. Leuk Lymphoma 2012; 54:1110-2. [PMID: 23088192 DOI: 10.3109/10428194.2012.726723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
MESH Headings
- Aged
- Brain Neoplasms/complications
- Brain Neoplasms/diagnosis
- Brain Neoplasms/therapy
- Diagnosis, Differential
- Epidural Neoplasms/complications
- Epidural Neoplasms/diagnosis
- Epidural Neoplasms/therapy
- Humans
- Janus Kinase 2/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Magnetic Resonance Imaging
- Male
- Mutation
- Myeloproliferative Disorders/complications
- Myeloproliferative Disorders/genetics
- Treatment Outcome
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12
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Imitola J, Pitt K, Peoples JL, Krynska B, Sheikh H, Kesari S, Azizi SA. Multifocal CNS infiltration of chronic lymphocytic leukemia in the form of small-cell solid metastatic lesions. J Neurooncol 2012; 109:213-5. [PMID: 22573347 DOI: 10.1007/s11060-012-0869-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 03/31/2012] [Indexed: 11/25/2022]
MESH Headings
- Aged
- Central Nervous System Neoplasms/metabolism
- Central Nervous System Neoplasms/secondary
- Central Nervous System Neoplasms/therapy
- Female
- Humans
- Immunoenzyme Techniques
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Magnetic Resonance Imaging
- Prognosis
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13
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Spectrum of neurologic complications in chronic lymphocytic leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 12:164-79. [PMID: 22192500 DOI: 10.1016/j.clml.2011.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Revised: 10/19/2011] [Accepted: 10/27/2011] [Indexed: 12/21/2022]
Abstract
Neurologic disease is believed to be an unusual complication during the course of chronic lymphocytic leukemia. Nevertheless, it has already been proven in autopsy series that the incidence of occult nervous system infiltration is much higher than was previously expected. The advent of more potent drugs to treat this lymphoproliferative disorder has brought a new hope for a possible cure in the future. However, an appropriate systemic treatment for central nervous system infiltration of this disease is still lacking. Also, due to the potent immunosuppressive properties of the agents used in the up-front treatment, for example, the purine nucleoside analogues, we have witnessed an increase in the incidence of opportunistic infections, with progressive multifocal leukoencephalopathy being one of the most serious. The goal of this review is to summarize the spectrum of neurologic derangements linked to chronic lymphocytic leukemia and to raise clinicians' awareness to recognize the possibility of such associations.
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14
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Tonino SH, Rijssenbeek AL, Oud ME, Pals ST, van Oers MH, Kater AP. Intracerebral Infiltration As the Unique Cause of the Clinical Presentation of Chronic Lymphocytic Leukemia/Small Lymphocytic Leukemia. J Clin Oncol 2011; 29:e837-9. [DOI: 10.1200/jco.2011.37.5055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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15
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Moazzam AA, Drappatz J, Kim RY, Kesari S. Chronic lymphocytic leukemia with central nervous system involvement: report of two cases with a comprehensive literature review. J Neurooncol 2011; 106:185-200. [PMID: 21769650 DOI: 10.1007/s11060-011-0636-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 06/17/2011] [Indexed: 10/18/2022]
Abstract
Central nervous system (CNS) involvement is a rare complication of chronic lymphocytic leukemia (CLL) with varied outcomes. We contribute two additional cases of CLL with CNS involvement. The clinical course and response to treatment are described. All 78 previously reported cases of CLL with CNS involvement are presented in this comprehensive review of the literature. CNS involvement of CLL is a rare complication that does not seem to correlate with any evident risk factors. Resolution of CNS symptoms can often be accomplished with intrathecal chemotherapy or irradiation. Early detection and treatment may result in better outcomes in this rare complication.
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MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor
- Central Nervous System Neoplasms/drug therapy
- Central Nervous System Neoplasms/pathology
- Central Nervous System Neoplasms/radiotherapy
- Combined Modality Therapy
- Fatal Outcome
- Female
- Flow Cytometry
- Gait Disorders, Neurologic/etiology
- Humans
- Hypesthesia/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/radiotherapy
- Leukemic Infiltration
- Leukocyte Count
- Magnetic Resonance Imaging
- Middle Aged
- Tomography, X-Ray Computed
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Affiliation(s)
- Alan A Moazzam
- Department of Neurosciences, Moores UCSD Cancer Center, University of California at San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093, USA
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16
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Kakimoto T, Nakazato T, Hayashi R, Hayashi H, Hayashi N, Ishiyama T, Asada H, Ishida A. Bilateral Occipital Lobe Invasion in Chronic Lymphocytic Leukemia. J Clin Oncol 2010; 28:e30-2. [DOI: 10.1200/jco.2009.23.8436] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Knop S, Herrlinger U, Ernemann U, Kanz L, Hebart H. Fludarabine may induce durable remission in patients with leptomeningeal involvement of chronic lymphocytic leukemia. Leuk Lymphoma 2009; 46:1593-8. [PMID: 16236614 DOI: 10.1080/10428190500178472] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Leptomeningeal involvement (LI) is a rare complication in the course of B-cell chronic lymphocytic leukemia (CLL). It is difficult to assess, thus several cases may go unrecognized. Here we report on six patients with LI of B-CLL. Neurologic symptoms were present in five of six patients. Cerebral MRI, although performed in all subjects, was diagnostic in two patients only. Examination of cerebrospinal fluid by cytology and immunophenotyping revealed LI in all six cases. One patient received whole brain irradiation, two patients received intrathecal therapy or intravenous fludarabine respectively. Clinical responses occurred in one patient after irradiation and two patients after fludarabine. Response in CSF was observed in all four evaluable patients after intrathecal therapy (n=2) and fludarabine (n=2). Survival for the patient who received irradiation was five months and for the two patients treated with intrathecal therapy three and six months respectively. One of the patients on fludarabine treatment survived for 21 months with an 11 month event-free survival for the CNS manifestations while the other patient has been in an ongoing meningeal CR and hematologic PR for 20 months. We conclude that fludarabine may be useful in meningeal involvement of CLL with impact on systemic disease.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Cerebrospinal Fluid/cytology
- Drug Evaluation
- Female
- Humans
- Injections, Intravenous
- Injections, Spinal
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Magnetic Resonance Imaging
- Male
- Meningeal Neoplasms/drug therapy
- Meningeal Neoplasms/mortality
- Meningeal Neoplasms/pathology
- Middle Aged
- Remission Induction/methods
- Retrospective Studies
- Survival Rate
- Vidarabine/administration & dosage
- Vidarabine/analogs & derivatives
- Vidarabine/therapeutic use
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Affiliation(s)
- Stefan Knop
- Department of Hematology and Oncology, Tübingen University Hospital, Tübingen, Germany.
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18
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Treppendahl MB, Andersen N, Jurlander J, Geisler C. A case of chronic lymphocytic leukemia with deletion 17p and bilateral retinal leukemic infiltrates. Eur J Haematol 2009; 82:79-80. [DOI: 10.1111/j.1600-0609.2008.01160.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Hanse MCJ, Van't Veer MB, van Lom K, van den Bent MJ. Incidence of central nervous system involvement in chronic lymphocytic leukemia and outcome to treatment. J Neurol 2008; 255:828-30. [PMID: 18446313 DOI: 10.1007/s00415-008-0710-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Revised: 06/09/2007] [Accepted: 07/20/2007] [Indexed: 11/25/2022]
Abstract
Leptomeningeal involvement in patients with CLL is relatively rare and the prognosis is usually considered to be poor. The authors reviewed all CLL patients treated in a tertiary referral center to assess the incidence and outcome of leptomeningeal involvement (LI) in CLL. They found an incidence of 1-2% of LI. Most of the patients with LI had a longterm survival, despite failure to clear the cerebrospinal fluid from tumor cells.
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MESH Headings
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Arachnoid/drug effects
- Arachnoid/pathology
- Arachnoid/radiation effects
- Cohort Studies
- Comorbidity
- Dementia, Vascular/etiology
- Humans
- Incidence
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/radiotherapy
- Male
- Meningeal Neoplasms/drug therapy
- Meningeal Neoplasms/mortality
- Meningeal Neoplasms/radiotherapy
- Meningeal Neoplasms/secondary
- Meninges/drug effects
- Meninges/pathology
- Meninges/radiation effects
- Middle Aged
- Pia Mater/drug effects
- Pia Mater/pathology
- Pia Mater/radiation effects
- Radiotherapy/adverse effects
- Radiotherapy/methods
- Retrospective Studies
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- M C J Hanse
- Dept. of Neuro-Oncology, Daniel den Hoed Cancer Center, 5201, 3008AE Rotterdam, The Netherlands
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20
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Lange CPE, Brouwer RE, Brooimans R, Vecht CJ. Leptomeningeal disease in chronic lymphocytic leukemia. Clin Neurol Neurosurg 2007; 109:896-901. [PMID: 17850954 DOI: 10.1016/j.clineuro.2007.07.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Revised: 07/03/2007] [Accepted: 07/25/2007] [Indexed: 11/16/2022]
Abstract
Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the western hemisphere, with an annual incidence of 3:100000. Commonly patients are asymptomatic but not rarely disease progression occurs in the setting of lymphadenopathy and extensive leukemic burden. Leptomeningeal involvement in patients with CLL is infrequent, with presenting symptoms of headache (23%), acute or chronic changes in mental status (28%), cranial nerve abnormalities (54%) including optic neuropathy (28%), weakness of lower extremities (23%) and cerebellar signs (18%). In this report, we discuss a CLL patient with leptomeningeal involvement, who presented with neurological symptoms as the first clinical sign, and a diagnosis of leptomeningeal was made based on CSF cytology and flow cytometry. Treatment consisted of radiation therapy and intrathecal chemotherapy with arabinoside-cytosine and systemic chemotherapy. On the basis of this patient-report together with 37 other previously reported cases, the clinical characteristics together with treatment options and outcome of leptomeningeal involvement in CLL are reviewed. Our case together with data from the literature indicate that a timely diagnosis and intensive treatment of leptomeningeal disease of CLL may lead to longstanding and complete resolution of neurological symptoms.
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Affiliation(s)
- C P E Lange
- Neuro-oncology Unit, Department of Neurology, Medical Centre, The Hague, The Netherlands.
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21
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Kalac M, Suvic-Krizanic V, Ostojic S, Kardum-Skelin I, Barsic B, Jaksica B. Central nervous system involvement of previously undiagnosed chronic lymphocytic leukemia in a patient with neuroborreliosis. Int J Hematol 2007; 85:323-5. [PMID: 17483076 DOI: 10.1532/ijh97.e0618] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Leukemic involvement of the central nervous system (CNS) in previously undiagnosed chronic lymphocytic leukemia (CLL) is very rare. We report the case of a 62-year-old man with neuroborreliosis in which cytologic, immunocytochemical, and flow cytometry analyses revealed the presence of clonal B-lymphocytes in the cerebrospinal fluid (CSF). After the patient received antimicrobial therapy, his meningeal symptoms cleared up, and the number of cells in the CSF decreased. Monoclonal lymphocytes were still detectable at the same percentage, however, despite systemic chlorambucil therapy. The application of intrathecal dexamethasone therapy led to the disappearance of B-cell CLL (B-CLL) cells in the CSF. We presumed that the neuroborreliosis enabled the transmigration of leukocytes, including B-CLL cells, across the blood-brain barrier via activation of matrix metalloproteinase 9, an enzyme known to open the blood-brain barrier.
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MESH Headings
- Anti-Infective Agents/administration & dosage
- Antineoplastic Agents, Alkylating/administration & dosage
- Antineoplastic Agents, Hormonal/administration & dosage
- Blood-Brain Barrier/enzymology
- Blood-Brain Barrier/pathology
- Central Nervous System/enzymology
- Central Nervous System/pathology
- Chlorambucil/administration & dosage
- Dexamethasone/administration & dosage
- Enzyme Activation/drug effects
- Humans
- Injections, Spinal
- Leukemia, Lymphocytic, Chronic, B-Cell/cerebrospinal fluid
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/enzymology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemic Infiltration/cerebrospinal fluid
- Leukemic Infiltration/drug therapy
- Leukemic Infiltration/enzymology
- Leukemic Infiltration/pathology
- Lyme Neuroborreliosis/cerebrospinal fluid
- Lyme Neuroborreliosis/complications
- Lyme Neuroborreliosis/drug therapy
- Lyme Neuroborreliosis/enzymology
- Lyme Neuroborreliosis/pathology
- Male
- Matrix Metalloproteinase 9/metabolism
- Middle Aged
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Affiliation(s)
- M Kalac
- Department of Medicine, Merkur University Hospital, Zagreb Medical School, Zagreb, Croatia.
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22
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Tsutsumi Y, Shiratori S, Nakata A, Kawamura T, Mashiko S, Ibata M, Mori A, Tanaka J, Asaka M, Imamura M, Masauzi N. Hyponatremia after administration of conditioning regimen in myelodysplastic syndrome with empty sella after glandula pituitaria surgery. Ann Hematol 2007; 86:843-4. [PMID: 17415566 DOI: 10.1007/s00277-007-0291-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 03/22/2007] [Indexed: 11/26/2022]
Affiliation(s)
- Yutaka Tsutsumi
- Department of Internal Medicine, Hakodate Municipal Hospital, Hakodate, Japan.
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23
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Nimubona S, Bernard M, Morice P, Brassier G, Caulet-Maugendre S, Carsin B, Meunier C, Lamy T. Complications of Malignancy. J Clin Oncol 2004; 22:374-6. [PMID: 14722047 DOI: 10.1200/jco.2004.03.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S Nimubona
- Department of Hematology, Pontchaillou Hospital, Rennes, France
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24
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Remková A, Bezayová T, Vyskocil M. B cell chronic lymphocytic leukemia with meningeal infiltration by T lymphocytes. Eur J Intern Med 2003; 14:49-52. [PMID: 12554011 DOI: 10.1016/s0953-6205(02)00207-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is a generalized malignancy of the lymphoid tissue characterized by an accumulation of monoclonal lymphocytes, usually of the B cell type. Involvement of the central nervous system is a rare complication, usually seen in T cell leukemias. We report a case of a 78-year-old woman with B cell CLL and meningeal infiltration by both B and T lymphocytes, although predominantly T lymphocytes. Neurological symptoms were the first manifestation of this disease. Computed tomography of the brain was negative. The diagnosis of leukemic meningitis was made on the basis of the examination of the cerebrospinal fluid, and which included cytological and flow cytometry analysis. The patient was given systemic chemotherapy in the form of chlorambucil and intrathecal administration of methotrexate and dexamethasone. After recovery, she had regular follow-up. We assume that this rare case of CLL might have been biclonal, with both B and T cell types.
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Affiliation(s)
- Anna Remková
- 1st Department of Internal Medicine, Teaching Hospital and School of Medicine, Comenius University, Mickiewiczova 13, SK-813 69, Bratislava, Slovak Republic
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25
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Abstract
Chronic lymphocytic leukemia continues to attract much basic and clinical research interest. Despite recent advances, the disease still has no established cure. Nonetheless, significant strides have been made in our understanding of the genetics, biology, and clinical staging of this disease. This understanding may improve our ability to segregate patients into subtypes that differ in their cytogenesis, propensity toward disease progression, or response to standard or innovative forms of therapy. Finally, several promising new modalities of treatment are being evaluated in clinical trials, involving novel drugs or drug-combinations, monoclonal antibodies, stem cell transplantation, or gene therapy.
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MESH Headings
- Adult
- Antibodies, Monoclonal/therapeutic use
- Antigens, CD/genetics
- Antimetabolites, Antineoplastic/therapeutic use
- Antineoplastic Agents/therapeutic use
- Apoptosis
- Biomarkers, Tumor
- CD79 Antigens
- Chromosome Aberrations
- Chromosomes, Human/genetics
- Chromosomes, Human/ultrastructure
- Cladribine/therapeutic use
- Combined Modality Therapy
- Cytokines/therapeutic use
- Female
- Genes, Immunoglobulin
- Genes, p53
- Genetic Therapy
- Hematopoietic Stem Cell Transplantation
- Humans
- Immunologic Deficiency Syndromes/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Neoplastic Stem Cells/pathology
- Prognosis
- Risk Factors
- Vidarabine/analogs & derivatives
- Vidarabine/therapeutic use
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Affiliation(s)
- T J Kipps
- Department of Medicine, University of California, San Diego, La Jolla 92093-0663, USA
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