Related Experiment Video
Updated: Oct 21, 2025
Murine Model of Leukemia Relapse to Induction Chemotherapy for Acute Lymphoblastic Leukemia
Published on: October 17, 2025
Isolated CNS Relapse in Acute Lymphoblastic Leukemia (ALL): An Experience from a Tertiary Care Center
Manvir Singh Tevatia1, Isha Sharma2, Toyaja Jadhav2
1Department of Pathology, Command Hospital, Pune, Maharashtra, India.
Insights
Central nervous system (CNS) relapse in acute lymphoblastic leukemia (ALL) can occur even after therapy. Early identification of isolated CNS relapse is crucial for timely treatment and improved outcomes in ALL patients.
Area of Science:
- Hematology
- Oncology
- Pediatric Oncology
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- Central nervous system (CNS) involvement is a known complication of ALL.
- Isolated CNS relapse can occur in ALL patients, necessitating specific diagnostic and therapeutic approaches.
Purpose of the Study:
- To investigate the clinical features, peripheral blood and bone marrow findings, immunophenotypic, and cytogenetic details of ALL cases with isolated CNS relapse.
- To analyze the outcomes of patients experiencing isolated CNS relapse.
- To emphasize the importance of early detection and management of isolated CNS relapse in ALL.
Main Methods:
- Retrospective analysis of 5 ALL cases with isolated CNS relapse treated between 2015 and 2019.
- Evaluation of clinical presentation, cerebrospinal fluid (CSF) analysis, and bone marrow (BM) examination.
- Review of immunophenotypic and cytogenetic data at diagnosis and during relapse.
Main Results:
- Patients' ages ranged from 7 months to 42 years, with 3 females.
- Two patients with isolated CNS relapse died within the study period.
- Cytogenetic abnormalities including t(9;22) and t(1;14) were observed in some cases; one patient was diagnosed with T-ALL.
Conclusions:
- Isolated CNS relapse in ALL, though less common due to therapeutic advances, requires high clinical suspicion for early diagnosis.
- Prompt identification and definitive therapy are essential for managing isolated CNS relapse in ALL.
- Understanding the parameters of isolated CNS relapse aids in refining treatment strategies and improving patient outcomes.
Abstract:
Aims and Objectives In this study the various parameters of acute lymphoblastic leukemia (ALL), including the clinical features, peripheral blood and bone marrow (BM) findings, immunophenotypic and cytogenetic details in ALL cases who had isolated relapse involving the central nervous system (CNS), were studied. Patients/Materials and Methods Duration of the study is from 2015 to 2019 in which 5 ALL cases were presented to this tertiary care center. The presenting symptoms varied from headache, fever, and distension of abdomen. These cases were either on therapy or post completion of chemotherapy. The diagnosis of CNS relapse followed after the examination of cerebrospinal fluid (CSF). Patients also underwent BM examination to rule out systemic relapse. Results Age of patients ranged from 7 months to 42 years. There were three female patients. Two patients had isolated CNS relapse 3.5 years after completing therapy and succumbed to their illness. Two patients had t(9;22) while one patient had t(1;14) cytogenetic abnormality at diagnosis. One patient was diagnosed as T-ALL. Treatment offered was German Multicentre ALL protocol for induction along with 10 cycles of maintenance. Conclusion The most common hematolymphoid malignancy in children namely ALL accounts for 75% of childhood leukemias. Complete remission rates reach up to 70 to 80%. CNS involvement is known to occur in these cases. CNS relapse may occur alone or with systemic relapse. Advances in therapeutic protocols along with CNS prophylaxis have drastically brought down the rates of CNS relapse. It is essential to maintain a high degree of suspicion so that these cases of isolated CNS relapse can be identified at the earliest and definitive therapy can be offered.
