Acute Lymphoblastic Leukemia Presenting Initially as Spinal Cord Compression: When Chemotherapy Alone Is Enough

Area of Science:

• Hematology
• Neurology
• Oncology

Background:

• Spinal cord compression (SCC) is an uncommon initial presentation of acute lymphoblastic leukemia (ALL).
• Most reported cases of SCC in ALL occur in pediatric patients.
• Adult onset SCC from ALL is exceptionally rare, lacking established treatment guidelines.

Observation:

• A 38-year-old male presented with back pain, gait instability, and urinary retention.
• Radiological imaging revealed thoracic spinal masses causing significant spinal canal narrowing and cord compression.
• Bone marrow biopsy confirmed acute lymphoblastic leukemia (ALL) with severe thrombocytopenia.

Findings:

• Immediate high-dose corticosteroids and systemic chemotherapy were initiated.
• The patient experienced symptom resolution without surgery or radiation.
• Complete remission of ALL was achieved after two chemotherapy courses, resolving SCC.

Implications:

• Chemotherapy alone can effectively manage spinal cord compression in adult ALL patients.
• This case suggests chemotherapy as a viable initial treatment for SCC in chemotherapy-naïve adult ALL.
• Further research is warranted to establish standardized treatment protocols for this rare presentation.