Leptomeningeal involvement in B-cell chronic lymphocytic leukemia: a case report and review of the literature

Abstract

BackgroundCentral nervous system involvement is considered a rare complication of chronic lymphocytic leukemia, and so there is the risk of being overlooked.Case presentationWe 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.ConclusionWe 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.

Venetoclax with high‐dose methotrexate and rituximab seem effective and well‐tolerated in the treatment of central nervous system involvement of chronic lymphocytic leukemia: A case report

“…Nevertheless, the initial contribution of methotrexate infusions and continuous oral corticosteroids cannot be ruled out to explain the clinical improvement. Indeed, previously reported cases show that intrathecal chemotherapy (methotrexate and cytarabine) is the most frequently given treatment for CLL with CNS involvement . Our patient's previous medical history of psychiatric disorders complicated the interpretation and feasibility of lumbar punctures.…”

Central nervous system localisation of chronic lymphocytic leukaemia, description of two very distinct cases and a review of the literature

“…In contrast to the most recent review by de Souza et al [14], describing 92 patients with CNS involvement of CLL, we did not focus specifically on immunophenotyping, but on the clinical presentation and complete diagnostic process [14]. …”

Brain biopsy in the diagnosis of leptomeningeal involvement in stage I chronic lymphocytic leukemia

“…No relationship between leptomeningeal infiltration and the stage or time of evolution of CLL has been described. Likewise, risk or predisposing factors have not been identified .…”

“…No relationship between leptomeningeal infiltration and the stage or time of evolution of CLL has been described. Likewise, risk or predisposing factors have not been identified [5]. Brain imaging (CT or MRI) have low sensitivity and specificity for the diagnosis of CNS involvement in CLL [5,6].…”