Early detection of meningeal localization in acute promyelocytic leukaemia patients with high presenting leucocyte count

Massimo Breccia, Ida Carmosino, Daniela Diverio, Silvia De Santis, Maria Stefania De Propris, Atelda Romano, Maria C. Petti, Franco Mandelli, Francesco Lo-Coco

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Extramedullary relapse occurs infrequently in acute promyelocytic leukaemia (APL) but has been increasingly reported after the advent of all-trans retinoic acid (ATRA) treatment, probably as a consequence of improved patient survival. We describe our single centre experience of six APL patients who had disease localization in the central nervous system (CNS). In three patients, clinical symptoms (headache and/or nausea) that presented during follow-up led to the performance of a lumbar puncture and detection of overt CNS infiltration. Two of these patients had simultaneous haematological relapse and one was in molecular remission when CNS leukaemia was documented. One patient with no local symptoms showed CNS infiltration at the time of molecular relapse. Following the introduction of routine lumbar puncture, carried out after front-line induction in all newly diagnosed patients with white blood cell count (WBC) greater than 10 × 109/l, two additional patients in molecular remission with no local symptoms were found to have initial APL localization in the CNS. Presenting features included in 6/6 patients an elevated WBC count (> 10 × 109/l) and a predominance of the PML/RAR bcr3 type (5/6 patients) and of microgranular morphology (5/6 patients). Our findings highlight the importance of carrying out lumbar puncture in APL patients presenting with high-risk features.

Original languageEnglish
Pages (from-to)266-270
Number of pages5
JournalBritish Journal of Haematology
Volume120
Issue number2
DOIs
Publication statusPublished - Jan 2003

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Acute Promyelocytic Leukemia
Leukocyte Count
Central Nervous System
Spinal Puncture
Recurrence
Tretinoin
Nausea
Headache
Leukemia

Keywords

  • Acute promyelocytic leukaemia
  • ATRA
  • CNS infiltration
  • Extramedullary relapse
  • PML/RARα

ASJC Scopus subject areas

  • Hematology

Cite this

Early detection of meningeal localization in acute promyelocytic leukaemia patients with high presenting leucocyte count. / Breccia, Massimo; Carmosino, Ida; Diverio, Daniela; De Santis, Silvia; De Propris, Maria Stefania; Romano, Atelda; Petti, Maria C.; Mandelli, Franco; Lo-Coco, Francesco.

In: British Journal of Haematology, Vol. 120, No. 2, 01.2003, p. 266-270.

Research output: Contribution to journalArticle

Breccia, M, Carmosino, I, Diverio, D, De Santis, S, De Propris, MS, Romano, A, Petti, MC, Mandelli, F & Lo-Coco, F 2003, 'Early detection of meningeal localization in acute promyelocytic leukaemia patients with high presenting leucocyte count', British Journal of Haematology, vol. 120, no. 2, pp. 266-270. https://doi.org/10.1046/j.1365-2141.2003.04056.x
Breccia, Massimo ; Carmosino, Ida ; Diverio, Daniela ; De Santis, Silvia ; De Propris, Maria Stefania ; Romano, Atelda ; Petti, Maria C. ; Mandelli, Franco ; Lo-Coco, Francesco. / Early detection of meningeal localization in acute promyelocytic leukaemia patients with high presenting leucocyte count. In: British Journal of Haematology. 2003 ; Vol. 120, No. 2. pp. 266-270.
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