A Case of Relapsed Chronic Myeloid Leukemia Admitted with the Complaints of Paraplegia and Urinary Incontinence

Ali Kutlucan^1, , Mehmet Daglı¹, Leyla Kutlucan², Seher Kır³, Abdulkadir Basturk¹, Ceyhan Ugurluoglu⁴, Hasan Acar⁵, Mehmet Sozen¹ and Kubra Turkay¹

¹Department of Internal Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey

²Department of Anesthesiology, Konya Training and Research Hospital, Konya, Turkey

³Department of Internal Medicine, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey

⁴Department of Pathology, Faculty of Medicine, Selcuk University, Konya, Turkey

⁵Department of Genetics, Faculty of Medicine, Selcuk University, Konya, Turkey

Cite this paper

Ali Kutlucan, Mehmet Daglı, Leyla Kutlucan, Seher Kır, Abdulkadir Basturk, Ceyhan Ugurluoglu, Hasan Acar, Mehmet Sozen and Kubra Turkay. A Case of Relapsed Chronic Myeloid Leukemia Admitted with the Complaints of Paraplegia and Urinary Incontinence. American Journal of Medical Case Reports. 2016; 4(4):126-129. doi: 10.12691/AJMCR-4-4-4

Abstract

Chronic myeloid leukemia (CML) is a clonal hematopoietic stem cell malignancy. In CML, extramedullary blastic crisis is a very rare condition in which the prognosis is even worse. Herein we presented a rare case of relapsed CML patient as blastic crisis with serious neurological symptoms because of central nervous system (CNS) infiltration. A 69-year-old male patient diagnosed with CML was admitted to hospital with complaints of weakness in legs, urinary incontinence, abnormal speech, and impaired vision. Deep tendon reflexes were bilaterally hypoactive in lower and upper extremities and Babinski reflex was negative. Immunophenotyping and cytological examination of CSF showed blastic cell infiltration. Also BCR-ABL mutation was positive in CSF and MR showed CNS involvement. So the patient diagnosed as “Myeloid blastic phase of CML with CNS involvement”. İmatinib therapy was replaced with dasatinib and intrathecal methotrexate, cytarabine and dexamethasone treatment was applied. Complaints of weakness, fatigue, urinary incontinence, leg weakness and inability to walk were completely resolved in three months. Extramedullary blastic crisis such as CNS involvement has been reported in a limited number in CML. Even if hematological and cytogenetic remission is provided, CML patients should be followed regularly. Any new clinical detail should be considered carefully and extramedullary involvement including CNS should be kept in mind.

Keywords

chronic myeloid leukemia, extramedullary blastic crisis, dasatinib, central nervous system infiltration

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Rabinowitz I, Larson RS. Chronic myeloid leukemia. In: Greer JP, Foerster J, Lukens JN, Rodgers GM, Paraskevas F, Glader B, editors. Wintrobe's clinical hematology. 11th ed. Philadelphia: Lippincott Williams & Wilkins; 2004. pp. 2235-2258.
[2]	Mughal TI, Goldman JM. Chronic myeloid leukemia: STI 571 magnifies the therapeutic dilemma. Eur J Cancer. 2001; 37: 561-568.
[3]	O’Brien SG, Guilhot F, Larson RA, et al. Imatinib compared with interferon and low dose cytarabine for newly diagnosed chronic phase chronic myeloid leukemia. N Engl J Med. 2003; 348: 994-1004.
[4]	Sattler M, Griffin JD. Molecular mechanisms of transformation by the BCR-ABL oncogene. Seminars in Hematology. 2003;40:4-10.
[5]	Calabretta B, Perrotti D. The biology of CML blast crisis. Blood. 2004;103:4010-4022.
[6]	Xu Z, Zheng M, Wu C, Ma Y, Meng L, Zhou J, Wang Y. The overwhelmingly positive response to Dasatinib of a patient with multiple blast crisis of chronic myeloid leukemia. Int J Clin Exp Med. 2015;8(1):1460–1466.
[7]	Lai SW, Huang TC, Chen JH, Wu YY, Chang PY. Dasatinib as the salvage therapy for chronic myeloid leukemia with blast crisis and central nervous system involvement: A case report. Oncol Lett. 2015;9(4):1957-1961.
[8]	Lindhorst SM, Lopez RD, Sanders RD. An Unusual Presentation of Chronic Myelogenous Leukemia: A Review of Isolated Central Nervous System Relapse. J Natl Compr Canc Netw. 2013; 11(7): 745-749.
[9]	Gomez J, Duenas V. Isolated Central Nervous System Relapse in Chronic Myeloid Leukemia. Case Rep Med. 2015;2015:232915.
[10]	Radhika N, Minakshi M, Rajesh M, Manas BR, Deepak Kumar M. Central nervous system blastcrisis in chronic myeloid leukemia on imatinib mesylate therapy: report of twocases. Indian J Hematol Blood Transfus. 2011;27(1):51-54.
[11]	Fuchs M, Reinhöfer M, Ragoschke-Schumm A, Sayer HG, Böer K, Witte OW, Hochhaus A, Axer H. Isolated central nervous system relapse of chronic myeloid leukemia after allogeneic hematopoietic stem cell transplantation. BMC Blood Disord. 2012; 12: 9.