Central nervous system recurrence ten years after remission of acute lymphoblastic leukemia

Therapy with vincristine and prednisone achieved a complete remission in a 10-year-old Caucasian girl with acute lymphoblastic leukemia. Maintenance therapy with 6-mercaptopurine was then administered for seven years, but prophylactic intrathecal chemotherapy and central nervous system (CNS) radiation were never given the patient. Ten years from the time of diagnosis, she presented with signs of increased intracranial pressure and a diagnosis of CNS leukemia was confirmed. At this time, however, no leukemia was detected on examination of her blood and bone marrow. She was successfully treated with intrathecal methotrexate and radiation therapy. After a careful search of the literature it has been concluded that this is the first reported case of such a long remission of acute lymphoblastic leukemia with subsequent relapse.