Flow cytometry for diagnosis of a rare case of chronic lymphocytic leukaemia presenting in the central nervous system and effective treatment with liposomal cytarabine
Małgorzata Krawczyk-Kuliś, Anna Kopińska, Joanna Dziaczkowska-Suszek, Sławomira Kyrcz-Krzemień
Am J Case Rep 2011; 12:145-149
Background: Chronic lymphocytic leukaemia presenting as an abnormality of the central nervous system is extremely rare, with very few cases in the literature, and the diagnosis is complicated. This is the first published case report on the efficacy of maintenance treatment with liposomal cytarabine of central nervous system involvement in chronic lymphocytic leukaemia in our department.
Case Report: We report the case of a 54-year-old male Caucasian Polish patient with a long (>10 years) history of chronic lymphocytic leukaemia who manifested cerebral symptoms. Magnetic resonance imaging revealed neoplastic meningitis. A flow cytometry analysis of cerebrospinal fluid confirmed the presence of clonal B lymphocytes. At first, the treatment was based on drugs such as methotrexate, cytarabine and dexamethasone, which were intrathecally administered. When complete remission had been reached, depot liposomal cytarabine (DepoCyte) administration was started. The patient received liposomal cytarabine every 3–4 weeks 7 times in total as a maintenance treatment and this therapy was well tolerated. Central nervous system treatment was performed parallel with systematic therapy (fludarabine and cyclophosphamide). Complete remission with minimal residual disease negativity in bone marrow was obtained. Complete remission in the central nervous system was confirmed by magnetic resonance imaging and cerebrospinal fluid is still kept 16 months after central nervous system remission.
Conclusions: This is the first therapeutic use of liposomal cytarabine as maintenance treatment in our clinic. Its use in conjunction with systematic chemotherapy appears to be effective and safe since complete remission has been achieved for 16 months since maintenance therapy began.
Keywords: chronic lymphocytic leukaemia, neoplastic meningitis, Immunophenotyping, intrathecal chemotherapy