Isolated Central Nervous System Blast Crisis of Chronic Myeloid Leukemia with Dasatinib Therapy

Background: Isolated central nervous system (CNS) blast crisis was uncommon in chronic myeloid leukemia (CML). Methods: The present study reported an interesting case of a CML patient administered with dasatinib presenting with headache and seizure unconsciousness. Imaging investigation, immunophenotyping, bone marrow cytology inspection, chromosomal analysis, and polymerase chain reaction (PCR) were performed on a 41-year-old CML patient. Results: Bone marrow examination revealed complete cytogenetic remission and there were no obvious abnormalities in head CT and MR. Cytomorphological examination of cerebrospinal fluid (CSF) showed 50% blasts. Flow cytometry analysis was showed 78.3% CSF cells expressing the specific myeloid antigens. PCR analysis on CSF cells was positive for BCR/ABL P210 fusion gene. All the above CSF findings were suggestive of CNS infiltrating isolated from bone marrow cytogenetic remission. Conclusions: Isolated CNS blast crisis of CML with dasatinib were rare. The mechanism still remains unclear and the treatment regimen requires further exploration. Flow cytometry showed great value to detect the blast cells in this patient.

Automated summary

Isolated CNS blast crisis in CML is rare, especially with dasatinib treatment. The use of various diagnostic methods, including imaging, immunophenotyping, and PCR, is crucial for evaluating and managing such cases. The identification of blast cells using flow cytometry is important for determining the extent of CNS involvement.