Involvement of the central nervous system in adult patients with acute myeloid leukemia

Abstract

Involvement of the central nervous system (CNS) arising in patients with acute myeloid leukaemia (AML) are rare at the time of diagnosis, but more often occur during relapse or after allogeneichematopoietic stem cell transplantation (allo-HSCT). Clinical manifestations include symptoms of increased intracranial pressure, cranial nerve palsies and altered mental status. Furthermore, headache, nausea, vomiting, visual changes, seizure and neurological deficits are often present .After reviewing the medical history, performing a physical examination, (including neurological examination), and before undertaking any invasive diagnostic procedures, it is necessary to rule out intracranial haemorrhage or the presence of brain mass or lesion using computed tomography, and/or magnetic resonance imaging. It is recommended that only then, can invasive diagnosticprocedures be performed such as lumbar puncture, (LP) or stereotactic biopsy. Once this is done and after neuro-infection being ruled out, the diagnosis of CNS disorders are based on either identifying the presence of pathological cells, depending on AML subtype, in cerebrospinal fluid, (CSF) or histopathological findings after stereotactic brain biopsy. For treatment, systemic and intrathecal chemotherapy with arabinoside cytosine and subsequent cranial radiotherapy are used. The response evaluation is performed by CSF cytology and/or flow cytometry at the time of subsequent LP and also by neuro-imaging studies. CNS involvement in AML is linked to an unfavourable prognosis and shorter overall survival and therefore these disorders are indications for carrying out the allo-HSCT procedure, irrespective of the cytogenetic risk of leukemia.