Conclusion:
Maintaining a high level of vigilance is essential when it comes to detecting CNS involvement in CML patients who have received imatinib treatment, especially those in a blast crisis. Aggressive treatment strategies, including intrathecal chemotherapy, adjusting TKI for better CNS penetration, and even considering allogeneic stem cell transplantation, are crucial in such cases. Additional research is warranted to improve the concept of CNS prophylaxis for high-risk patients.
References :
  1. Rowley JD: Letter: a new consistent chromosomal abnormality in chronic myelogenous leukaemia identified by quinacrine fluorescence and Giemsa staining. Nature 1973;243:290–293. https://doi.org/10.1038/243290a0
  2. Kantarjan HM, Keating MJ, Talpaz M: Chronic myelogenous leukemia in blast crisis: analysis of 242 patients. Am J Med 1987;83:445–454. DOI: 10.1016/0002-9343(87)90754-6  
  3. Canellos G: Clinical characteristics of the blast phase of chronic granulocytic leukemia. Hematol Oncol Clin North Am 1990;4:359–376. DOI: 10.1016/S0889-8588(18)30492-1
  4. Specchia G, Palumbo G, Pastore D, Mininni D, Mestice A, Liso V: Extramedullary blast crises in chronic myeloid leukemia. Leuk Res 1996;20:905–908. DOI: 10.1007/s12288-014-0471-4
  5. Matsuda M, Morita Y: Extramedullary blast crisis derived from 2 different clones in the central nervous system and neck during complete cytogenetic remission of chronic myelogenous leukemia treated with imatinib mesylate. Int J Hematol 2005;81:307–309. DOI: 10.1532/IJH97.04188
  6. Ganessan K, Goel R, Kumar K, Bakhshi S: Biphenotypic extramedullary blast crisis as a presenting manifestation of Philadelphia chromosome-positive CML in a child. Pediatr Hematol Oncol 2007;24:195–198. DOI: 10.1080/08880010701198787
  7. Al-Rayes HM, Al-Shaikh AA, Halim MA, Al-Qurashi FS, Al-Jurf MM: Leukemic synovitis as a presentation of myelomonocytic blast crisis of chronic myeloid leukemia. Saudi Med J 2001;22:808–811. https://pubmed.ncbi.nlm.nih.gov/11590459/
  8. Jin GN, Zou P, Chen WX, Ding ZY, Zhou H: Fluorescent in situ hybridization diagnosis of extramedullary nodal blast crisis. Diagn Cytopathol 2013;41:253–256. DOI:10.1002/dc.21795
  9. Shune L, Cayci Z, Rogosheske J, Brunstein C, Ustun C: Extramedullary blastic crisis in abdominal lymph nodes in a patient with chronic myelogenous leukemia on imatinib. Leuk Res 2012;36:e131–e132. DOI: 10.1016/j.leukres.2012.02.024
  10. Yu HH, Lu MY, Lin DT, Lin KH, Tang JL, Jou ST: Pathological fracture as a manifestation of extramedullary blastic crisis in chronic myelogenous leukemia: report of one case. Acta Paediatr Taiwan 2006;47:150–154. https://pubmed.ncbi.nlm.nih.gov/17078470/
  11. Rajappa S, Uppin SG, Raghunadharao D, Rao IS, Surath A: Isolated central nervous system blast crisis in chronic myeloid leukemia. Hematol Oncol 2004;22:179–181. DOI: 10.1002/hon.737
  12. Radhika N, Minakshi M, Rajesh M, Manas BR, Kumar MD: Central nervous system blast crisis in chronic myeloid leukemia on imatinib mesylate therapy: report of two cases. Indian J Hematol Blood Transfus 2011;27:51–54. DOI: 10.1007/s12288-011-0055-5
  13. Kim Hj, Jung CW, Kim K: Isolated blast crisis in CNS in a patient with chronic myelogenous leukemia maintaining major cytogenetic response after imatinib. J Clin Oncol 2006;24:4028–4029. DOI: 10.1200/JCO.2006.05.5608
  14. Bornhauser M, Jenke A, Freiberg-Richter J, Radke J, Schuler US, Mohr B, et al: CNS blast crisis of chronic myelogenous leukemia in a patient with major cytogenetic response in bone marrow associated with low levels of imatinib mesylate and its N-desmethylated metabolite in cerebral spinal fluid. Ann Hematol 2004;83:401–402. DOI: 10.1007/s00277-003-0829-4
  15. Wolff NC, Richardson JA, Egorin M, Ilaria RL Jr: The CNS is a sanctuary for leukemic cells in mice receiving imatinib mesylate for Bcr/Abl-induced leukemia. Blood 2003;101:5010–5013. DOI: 10.1182/blood-2002-10-3059
  16. Isobe Y, Sugimoto K, Masuda A, Hamano Y, Oshimi K: Central nervous system is a sanctuary site for chronic myelogenous leukemia treated with imatinib mesylate. Intern Med 2009;39:408–418. DOI: 10.1111/j.1445-5994.2009.01947.x
  17. Cortes J: Central nervous system involvement in adult acute lymphoblastic leukemia. Hematol Oncol Clin North Am 2001;15:145–162. DOI: 10.1016/s0889-8588(05)70203-3
  18. O’Hare T, Walters DK, Stoffregen EP, Jia T, Manley PW, Mestan J, et al: In vitro activity of Bcr-Abl inhibitors AMN107 and BMS-354825 against clinically relevant imatinib-resistant Abl kinase domain mutants. Cancer Res 2005;65:4500–4505. DOI: 10.1158/0008-5472.CAN-05-0259
  19. Porkka K, Koskenvesa P, Lundan T, Rimpilainen J, Mustjoki S, Smykla R, et al: Dasatinib crosses the blood-brain barrier and is an efficient the therapy for central nervous system Philadelphia chromosome-positive leukemia. Blood 2008;112:1005–1012. DOI: 10.1182/blood-2008-02-140665