Excellent response of chemotherapy-resistant B-cell-type chronic lymphocytic leukemia with meningeal involvement to rituximab

被引：19

作者：

Watanabe N. ^{[1
]}

Takahashi T. ^{[1
]}

Sugimoto N. ^{[1
]}

Tanaka Y. ^{[1
]}

Kurata M. ^{[1
]}

Matsushita A. ^{[1
]}

Maeda A. ^{[1
]}

Nagai K. ^{[1
]}

Nasu K. ^{[2
]}

机构：

[1] Department of Hematology and Clinical Immunology, Kobe City General Hospital, Chuo-ku, Kobe 650-0046

[2] Department of Clinical Pathology, Kobe City General Hospital, Kobe

来源：

International Journal of Clinical Oncology | 2005年 / 10卷 / 5期

关键词：

Chemotherapy-resistant CLL; Chronic lymphocytic leukemia; Intrathecal chemotherapy; Meningeal involvement; Rituximab;

D O I：

10.1007/s10147-005-0496-7

中图分类号：

学科分类号：

摘要：

A 70-year-old woman was diagnosed with B-cell-type chronic lymphocytic leukemia (B-CLL) in May 2001. Initial white blood cell (WBC) count was 37 × 109/l and most of the cells were mature small lymphocytes. Surface antigen analysis of these lymphocytes revealed positive reactions for CD19, 20, 25, 5, and λ-light chain. Despite her Rai stage-0 status, various treatments were ineffective, including cyclophosphamide; fludarabine; 6-mercaptopurine; a combination of vincristine, cyclophosphamide, prednisolone, and adriamycin; and etoposide. Her WBC count increased, ranging from 150 to 450 × 109/l, with marked splenomegaly, and symptoms of meningitis, such as headache, ophthalmalgia, hearing disturbance, and abnormal behavior, being manifested. The WBC count in the cerebrospinal fluid was elevated to 134/μl. The surface phenotype of these cells was identical to that of circulating lymphocytes, indicating meningeal involvement of leukemia, a rare complication in B-CLL. At the time of this WBC elevation, 24% of circulating lymphocytes had prominent nucleoli, indicating progression of the disease to CLL/prolymphocytic leukemia. Her symptoms disappeared after repeated intrathecal injections of methotrexate and dexamethazone. After four courses of treatment of the refractory B-CLL with rituximab, an anti-CD20 monoclonal antibody, the WBC count returned to normal levels and the splenomegaly disappeared. She is currently well, with sustained remission, as of April 2004. © The Japan Society of Clinical Oncology 2005.

引用

页码：357 / 361

页数：4

共 33 条

[1]

Murakami M., Nakajima K., Yamazaki K., Et al., Effects of breeding environments on generation and activation of autoreactive B-1 cells in anti-red blood cell autoantibody transgenic mice, J Exp Med, 185, pp. 791-794, (1989)

[2]

Getaz E.P., Miller G.J., Spinal cord involvement in chronic lymphocytic leukemia, Cancer, 43, pp. 1858-1861, (1979)

[3]

Steinberg J.P., Pecora M., Lokey J.L., Leukemic meningitis in B-cell chronic lymphocytic leukemia, Cancer Treat Rep, 55, pp. 1937-1942, (1985)

[4]

Singh A.K., Thompson R.P.H., Leukemic meningitis in chronic lymphocytic leukemia, Acta Haematol, 175, pp. 113-115, (1986)

[5]

Stagg M.P., Gumbert C.H., Chronic lymphocytic leukemic meningitis as a cause of the syndrome of inapproproiate secretion of antidiuretic hormone, Cancer, 60, pp. 191-192, (1987)

[6]

Cash J., Fehir K.M., Pollack M.S., Meningeal involvement in early stage chronic lymphocytic leukemia, Cancer, 59, pp. 798-800, (1987)

[7]

Garofalo M., Murali R., Halperin I., Et al., Chronic lymphocytic leukemia with hypothalamic invasion, Cancer, 64, pp. 1714-1716, (1989)

[8]

Fain J.S., Naeim F., Becker D.P., Et al., Chronic lymphocytic leukemia presenting as a pituitary mass lesion, Can J Neurol Sci, 19, pp. 239-224, (1992)

[9]

Ruiz P., Moezzi M., Chamizo W., Et al., Central nervous system expression of monoclonal paraprotein in chronic lymphocytic leukemia patient, Acta Haematol, 88, pp. 37-40, (1992)

[10]

Thiruvengadam R., Bernstein Z.P., Central nervous system involvement in prolymphocytic transformation of chronic lymphocytic leukemia, Acta Haematol, 87, pp. 163-164, (1992)

← 1 2 3 4 →