Table 2.

Summary of the patient’s treatment regimens and associated complications.

Time Period Following Initial B-ALL Diagnosis	Event	Treatment	Complications
Initial diagnosis		COG AAL1131 very high-risk arm with CNS involvement IT cytarabine IT methotrexate	Persistent numbness of right cheek CN deficits: CN VI and VII palsy, CN V dysfunction (tooth pain); lumbar radicular pain
3 months	Symptomatic worsening of neurological disease	Oral dexamethasone IV vincristine IV PEG asparaginase	Marrow relapse (15% blasts in peripheral blood and 81% leukemic blasts in BM)
5 months	Very early combined relapse	Reinduction chemotherapy with hyper-CVAD IV cyclophosphamide IV vincristine IV doxorubicin Oral dexamethasone IT cytarabine High-dose IV methotrexate High-dose IV cytarabine IT methotrexate IV rituximab	Persistent left-sided motor weakness of the mouth
7 months	HSCT	Preparative regimen IV fludarabine IV cyclophosphamide TBI at a total dose of 1200 cGy (150-cGy fractions twice daily on days −7 to −4) Stem cell transplant dose: 3.8 × 107 total nucleated cells/kg	Grade II acute GVHD of the upper and lower GI tract
16 months	Post-transplantation relapse 1	R-MOAD IV rituximab IV methotrexate IV vincristine IV PEG asparaginase Oral dexamethasone	Symptomatic cardiac relapse
22 months	Refractory disease	IT cytarabine IV etoposide IV cyclophosphamide	Death due to severe LV systolic dysfunction and loss of AV conduction

Abbreviations: ALL, acute lymphoblastic leukemia; AV, atrioventricular; BM, bone marrow; cGY, cobalt gray; COG, Children’s Oncology Group; CNS, central nervous system; IT, intrathecal; CN, cranial nerve; IV, intravenous; GI, gastrointestinal; GVHD, graft versus host disease; HSCT, hematopoietic stem cell transplant; LV, left ventricle; MLL, mixed-lineage leukemia; TBI, total-body irradiation