Successful Treatment of Isolated Central Nervous System Relapse with Intrathecal Chemotherapy in an Adolescent with Acute Promyelocytic Leukemia

초록

Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML) characterized by translocation of chromosomes 15 and 17 (t(15;17)), which rarely oc-curs in the pediatric population. Isolated central nervous system (CNS) relapse is par-ticularly rare in children with APL, and a standard treatment has not yet been established. In this case, a 15-year-old male adolescent with APL had no CNS in-volvement at the initial diagnosis. After remission induction therapy with idarubicin, all-trans retinoic acid, and intrathecal (IT) cytarabine, a bone marrow (BM) study re-vealed morphological and cytogenetic complete remission. However, immature mye-loid cells and blasts were observed in the cerebrospinal fluid (CSF). IT triple chemo-therapy (ITT) consisting of cytarabine, methotrexate, and hydrocortisone was ad-ministered in addition to the planned systemic chemotherapy. ITT was performed weekly for 6 weeks with consolidation therapy, and then every 3 months for 2 years during the period of maintenance therapy. Abnormal immature cells were no longer detected after the second ITT administration. The patient survived without evidence of BM or CNS relapse until 1 year after treatment completion. The combination of IT chemotherapy might be a possible treatment option for CNS relapse in patients with APL, and further studies are needed to establish an optimal treatment strategy for them.

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