Table 1.
Patients | Patient 1 | Patient 2 | Patient 3 | Patient 4 | ||||
---|---|---|---|---|---|---|---|---|
Age | 36 | 48 | 48 | 65 | ||||
Sex | Male | Female | Female | Male | ||||
ECOG | 4 | 2 | 2 | 1 | ||||
Prior therapies | Induction therapy: MVP + imatinib Cycles of intrathecal injection Unrelated-HSCT |
Induction therapy: DVLP + imatinib Cycles of consolidation therapy Cycles of intrathecal injection HD-MTX,HD-MTX + VP + imatinib |
Induction therapy: VDCP Cycles of consolidation therapy Sib-HSCT |
Induction therapy: IVP + nilotinib | ||||
Relapsed/refractor y status | 1st CNS relapse postinduction therapy within 2 months; 2nd CNS relapse post-HSCT within 2 years | CNS relapse postconsolidation therapy + imatinib within 2 years | CNS relapse post-sib-HSCT within 4 months | In remission | ||||
Time (months) to progression or last follow-up | 3 months to relapse | CR in 12 months | CR in 10 months | CR until now | ||||
Clinical response | Before | After | Before | After | Before | After | Before | After |
Complaints | Headache, dizziness, fatigue, epileptic seizures, impaired consciousness | Visual loss | Headache, vomiting and visual loss | Visual loss | Double vision | Normal | Normal | Normal |
Symptoms | Visual loss in both eyes, bilateral pupillary light reflex disappeared, left central facial palsy, bilateral Babinski's sign positive, limb muscle strength decreased | Visual loss in both eyes, left central facial palsy disappeared, bilateral Babinski's sign became negative, limb muscle strength improved (upper) | Normal | Normal | Left abducent paralysis | Normal | Normal | Normal |
GCS score | 9 | 15 | 15 | 15 | 15 | 15 | 15 | 15 |
NIHSS score | 21 | 3 | 0 | 0 | 0 | 0 | 0 | 0 |
Barthel index | 0 | 50 | 100 | 100 | 100 | 100 | 100 | 100 |
BM | CR | CR | CR | CR | CR | CR | CR | CR |
Molecular | BCR/ABL 4294/10,000 abl copies |
BCR/ABL <10/10,000 abl copies |
BCR/ABL 33/10,000 abl copies |
BCR/ABL 35/10,000 abl copies |
MRD 2.5 × 10−4 by flow cytometry | MRD 0 × 10−4 by flow cytometry | MRD 5.7 × 10−4 by flow cytometry | MRD 0 × 10−4 by flow cytometry |
CSF | Positive | Negative | Negative | Negative | Negative | Negative | Negative | Negative |
Molecular | BCR/ABL positive | BCR/ABL positive | BCR/ABL positive | BCR/ABL negative | MRD 2.47% by flow cytometry | MRD 0 × 10−2 by flow cytometry | BCR/ABL negative | BCR/ABL negative |
MRI | Signal in the pontine parenchyma was slightly high and the end of the central aqueduct and four ventricle | The pontine dorsal swelling was significantly reduced and the degree of stenosis reduced | Negative | Negative | Pituitary tumor in the sellar region | Tumor almost disappeared | N/A | N/A |
CRS grade | 1 | 1 | 1 | 1 | ||||
ICE score | 9 | 10 | 10 | 10 | ||||
ICANS grade | 1 | 1 | 1 | 1 |