Infiltration of the central nervous system in patients with chronic lymphatic leukemia

Caballero, Clara Auría; Cebrian, Flor Yus; Parra Salinas, Ingrid Magnolia

doi:10.1016/j.medcle.2023.09.007

array:24 ["pii" => "S2387020623003947" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.09.007" "estado" => "S300" "fechaPublicacion" => "2023-10-27" "aid" => "6307" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2023;161:361-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775323003123" "issn" => "00257753" "doi" => "10.1016/j.medcli.2023.05.014" "estado" => "S300" "fechaPublicacion" => "2023-10-27" "aid" => "6307" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2023;161:361-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "Carta al Editor" "titulo" => "Infiltración del sistema nervioso central en pacientes con leucemia linfática crónica" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "361" "paginaFinal" => "362" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Infiltration of the central nervous system in patients with chronic lymphatic leukemia" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Clara Auría Caballero, Flor Yus Cebrian, Ingrid Magnolia Parra Salinas" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Clara Auría" "apellidos" => "Caballero" ] 1 => array:2 [ "nombre" => "Flor Yus" "apellidos" => "Cebrian" ] 2 => array:2 [ "nombre" => "Ingrid Magnolia" "apellidos" => "Parra Salinas" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020623003947" "doi" => "10.1016/j.medcle.2023.09.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623003947?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323003123?idApp=UINPBA00004N" "url" => "/00257753/0000016100000008/v1_202310180449/S0025775323003123/v1_202310180449/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020623003959" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.05.020" "estado" => "S300" "fechaPublicacion" => "2023-10-27" "aid" => "6309" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2023;161:362-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Isolated hypoglossal nerve palsy as an initial manifestation of a lung adenocarcinoma (occipital condyle syndrome)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "362" "paginaFinal" => "363" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Parálisis aislada del nervio hipogloso como manifestación inicial de un adenocarcinoma pulmonar (síndrome del cóndilo occipital)" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1614 "Ancho" => 2925 "Tamanyo" => 528093 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "(A) Detail of the neurological examination showing tongue deviation to the left and ipsilateral atrophy. (B) Cross section of the cranial tomography showing an osteolytic lesion at the level of the left condyle (arrow)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Antonio Bustos-Merlo, Antonio Rosales-Castillo, Jessica Ramírez Taboada" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Antonio" "apellidos" => "Bustos-Merlo" ] 1 => array:2 [ "nombre" => "Antonio" "apellidos" => "Rosales-Castillo" ] 2 => array:2 [ "nombre" => "Jessica" "apellidos" => "Ramírez Taboada" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775323003147" "doi" => "10.1016/j.medcli.2023.05.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323003147?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623003959?idApp=UINPBA00004N" "url" => "/23870206/0000016100000008/v1_202310190859/S2387020623003959/v1_202310190859/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2387020623003996" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.06.010" "estado" => "S300" "fechaPublicacion" => "2023-10-27" "aid" => "6382" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2023;161:359-60" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Scientific letter" "titulo" => "Influence of the SARS-CoV-2 pandemic on ICU admissions for severe acute poisoning" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "359" "paginaFinal" => "360" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Influencia de la pandemia por SARS-CoV-2 en los ingresos en UCI por intoxicación aguda grave" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Paula Solís Albamonte, Carolina Soledad Romero García, Eva María Mateo Rodríguez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Paula" "apellidos" => "Solís Albamonte" ] 1 => array:2 [ "nombre" => "Carolina Soledad" "apellidos" => "Romero García" ] 2 => array:2 [ "nombre" => "Eva María" "apellidos" => "Mateo Rodríguez" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623003996?idApp=UINPBA00004N" "url" => "/23870206/0000016100000008/v1_202310190859/S2387020623003996/v1_202310190859/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Infiltration of the central nervous system in patients with chronic lymphatic leukemia" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "361" "paginaFinal" => "362" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Clara Auría Caballero, Flor Yus Cebrian, Ingrid Magnolia Parra Salinas" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Clara Auría" "apellidos" => "Caballero" "email" => array:1 [ 0 => "cauriac91@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Flor Yus" "apellidos" => "Cebrian" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Ingrid Magnolia" "apellidos" => "Parra Salinas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Hematología, Hospital de Barbastro, Barbastro, Huesca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Hematología, Hematología Hospital de San Jorge, Huesca, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infiltración del sistema nervioso central en pacientes con leucemia linfática crónica" ] ] "textoCompleto" => "Central nervous system (CNS) infiltration in patients with chronic lymphocytic leukaemia (CLL), although rare (0.8–2% in pre-mortem studies and 8–71% in post-mortem studies),<a class="elsevierStyleCrossRef" href="#bib0005">1</a> is one of the most common extramedullary manifestations.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> This discrepancy in pre- and post-mortem incidence is due to the fact that CLL cells often migrate to the CNS, but rarely cause neurological symptoms.Diagnosing these patients is challenging because the identification of such cells in the CNS does not always mean that symptoms are secondary to CLL.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>We report the case of a 57-year-old man with a history of B-CLL stage A0 and mild splenomegaly. He remained asymptomatic with progression of lymphocytosis for 2 years until he developed progressive lower-limb proximal paresis (of months of progression), without sensory deficit or constitutional symptoms.After the electromyographic study (compatible with acute phase polyradiculoneuropathy), magnetic resonance imaging ruled out brain and vertebral lesions, and described associated multiple-lymphadenopathy. The immunophenotypic study of cerebrospinal fluid (CSF) was compatible with B-CLL infiltration.The patient was diagnosed with B-CLL, non-mutated for the heavy chain gene (IGHV), stage II-B with CSF involvement. Treatment was initiated with weekly triple intrathecal therapy (methotrexate 12 mg + cytarabine 30 mg + hydrocortisone 20 mg). After 5 doses, given the persistence of symptomatology and aberrant lymphocytes in the CSF, it was decided to initiate systemic treatment with ibrutinib (420 mg/24 h). After 12 days, progressive improvement was observed until total resolution of symptoms. Currently (24 months later) the patient is on the same treatment with good tolerance and response.Neurological infiltration in patients with CLL should be suspected in subacute or chronic neurological conditions with multifocal involvement.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>The 80 patients in the review by Moazzam et al.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> coincide with our case both in the mean latency time between CLL diagnosis and neurological manifestations (2.62 years) and in the absence of disease on neuroimaging (only one third showed abnormalities).The review by Strati et al.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> studied 4,174 patients with CLL and neurological symptoms and looked at the incidence of CNS infiltration by CLL with CSF flow cytometry (FCM) and brain MRI; 18 (0.4%) had CLL infiltration. Although CSF FCM is necessary in most cases to confirm the diagnosis and is very sensitive (89%) for detecting CLL cells, it has a low specificity (42%) for differentiating between CLL infiltration and other causes.Wanquet et al.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> reviewed 30 cases of CNS-infiltrating CLL: 20 patients had never been treated (naive). Of these, 10 were treated with systemic chemotherapy regimens (with/without TIT) and 8 achieved a durable response (33 months: 4–78). In contrast, previously treated (non-naive) patients were treated with systemic regimens (70% with TIT), in which 50% required 3 additional lines (2–7) of treatment. Previously heavily treated patients who received treatment with ibrutinib 4/4 achieved CR.Recent publications describe the efficacy of ibrutinib (Bruton's tyrosine kinase inhibitor) in inhibiting the proliferation and survival of neoplastic B-cells as well as lymphoid migration to extramedullary tissues, offering new therapeutic possibilities.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a>Regarding prognosis, both Moazzam et al.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> and Strati et al.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> reported a median latency time between CLL diagnosis and death of 12 months. Wanquet et al.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> described a 5-year overall survival of 72% in naïve patients and 48% in non-naïve patients; with a 5-year progression-free survival of 43% and 0%, respectively. The 17p deletion was significantly associated with worse progression-free survival: the authors concluded that the prognosis in these cases depends more on the characteristics of the CLL than on the infiltration itself.In our case, a naïve patient without 17p deletion, the good clinical outcome 24 months after ibrutinib initiation is in line with that described by Wanquet et al.Because there is no standard protocol for CLL with CNS involvement, it is important to accumulate case series for a better understanding of the disease and the advent of new drugs.Conflict of interestThe authors declare that they have no financial interests or personal relationships that may have influenced the preparation of this paper." "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of central nervous system involvement in chronic lymphocytic leukemia and outcome to treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.C. Hanse" 1 => "M.B. Van’t Veer" 2 => "K. Van Lom" 3 => "M.J. Van den Bent" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00415-008-0710-4" "Revista" => array:7 [ "tituloSerie" => "J Neurol." "fecha" => "2008" "volumen" => "255" "numero" => "6" "paginaInicial" => "828" "paginaFinal" => "830" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18446313" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Central nervous system lymphoma in a patient with chronic lymphocytic leukemia: a case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Albakr" 1 => "W. Alhothali" 2 => "P. Samghabadi" 3 => "L. Maeda" 4 => "S. Nagpal" 5 => "A. Ajlan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cureus" "fecha" => "2018" "volumen" => "30" "paginaInicial" => "10" "paginaFinal" => "11" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and characteristics of central nervous system involvement by chronic lymphocytic leukemia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Strati" 1 => "J.H. Uhm" 2 => "T.J. Kaufmann" 3 => "C. Nabhan" 4 => "S.A. Parikh" 5 => "C.A. Hanson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3324/haematol.2015.136556" "Revista" => array:7 [ "tituloSerie" => "Haematologica." "fecha" => "2016" "volumen" => "101" "numero" => "4" "paginaInicial" => "458" "paginaFinal" => "465" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26819053" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Activity of ibrutinib in mantle cell lymphoma patients with central nervous system relapse" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Bernard" 1 => "L. Goldwirt" 2 => "S. Amorim" 3 => "P. Brice" 4 => "J. Brière" 5 => "E. de Kerviler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2015-05-647834" "Revista" => array:7 [ "tituloSerie" => "Blood." "fecha" => "2015" "volumen" => "126" "numero" => "14" "paginaInicial" => "1695" "paginaFinal" => "1698" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26239089" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of central nervous system involvement in chronic lymphocytic leukaemia: a retrospective cohort of 30 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Wanquet" 1 => "R. Birsen" 2 => "C. Bonnet" 3 => "M. Boubaya" 4 => "S. Choquet" 5 => "J. Dupuis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjh.14387" "Revista" => array:7 [ "tituloSerie" => "Br J Haematol." "fecha" => "2017" "volumen" => "176" "numero" => "1" "paginaInicial" => "37" "paginaFinal" => "49" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27858991" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016100000008/v1_202310190859/S2387020623003947/v1_202310190859/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016100000008/v1_202310190859/S2387020623003947/v1_202310190859/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623003947?idApp=UINPBA00004N"]

ISSN: 2387-0206

Launched in 1943, Medicina Clínica is a fortnightly journal aimed at the promotion of clinical research and practice among internal medicine and other specialists. The key characteristics of Medicina Clínica are the scientific and methodological rigor of its manuscripts, the topicality of its contents, and, especially, its practical focus with highly useful information for clinical practice. Medicina Clínica is predominantly interested in publishing original research manuscripts, which are rigorously selected according to their quality, originality, and interest, and also in continued medical education-oriented manuscripts, which are commissioned by the journal to relevant authors (Editorials, Reviews, and Diagnosis and Treatment). These manuscripts contain updated topics with a major clinical or conceptual relevance in modern medicine. The journal adheres to the standards of academic research publications in all aspects including peer-review and ethical principles. Medicina Clínica is included in the General and Internal Medicine category of Thomson Reuters.

See more Open Access Option

Indexed in:

Current Contents/Clinical Medicine, Journal Citation Reports, SCI-Expanded, Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME, MEDES, PASCAL, SCOPUS, SciVerse ScienceDirect

Subscribe:

Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.6

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

3.1

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.371

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.511

View more metrics

Journal Information

Previous article | Next article

Vol. 161. Issue 8.