Table 3.
CNS relapse presentation, treatment, and course of disease
| Pt | Time from diagnosis to CNS relapse (months) | Relapse presentation | Relapse therapy | Disease status and time to relapse | Disease course after relapse |
|---|---|---|---|---|---|
| 1 | 5 |
Facial nerve palsy, strabismus Tumour in CT NBL cells in CSF and in removed tumour |
Surgery, RTX, chemotherapy, intrathecal chemotherapy | CR; on treatment after induction and surgery | Local progression 6 months from relapse, death 7 months from relapse |
| 2 | 6 |
Intracranial bleeding No tumour in CT NBL cells in removed tumour |
Surgery | CR; on treatment – before HDC | Died 2 weeks after event |
| 3 | 5 |
Accidental diagnosis CT: infiltration of meninges, bleeding into the tumour |
Chemotherapy, intrathecal chemotherapy |
PR; on treatment - after induction |
Died 3 weeks after event bleeding into tumour |
| 4 | 12 |
Intracranial bleeding No radiological symptoms NBL in postmortem examination |
No therapy |
CR; on treatment - therapy of MRD |
Died 5 days after event |
| 5 | 8 |
Headache, nausea, vomiting Tumour in CT NBL cells in removed tumour |
Surgery, radiotherapy, chemotherapy, 13 cis RA | CR; after end of treatment | CR in CNS; disseminated bone relapse 39 months after relapse; no 3rd line treatment. Died of disease |
| 6 | 15 | Facial nerve palsy | Chemotherapy | PR; on treatment – therapy of MRD | Local progression and death 3 months after relapse |
| 7 | 26 |
Headache, nausea, vomiting Tumour in CT |
Chemotherapy, radiotherapy, no surgery (tumour regression on chemotherapy) | CR; after end of treatment | Alive in CR > 9 years after relapse |
| 8 | 8 |
Intracranial bleeding No radiological symptoms NBL in postmortem examination |
No therapy | CR; on treatment – after radiotherapy | Died 2 days after event |
| 9 | 20 |
Headache, nausea, vomiting 2 tumours in CT NBL cells in removed tumour |
Surgery, chemotherapy, radiotherapy, ibritumomab | CR; 3 months after end of treatment | Alive in CR, 2,5 years after relapse |
| 10 | 8 |
Intracranial bleeding No radiological symptoms NBL in postmortem examination |
No therapy | PR; on treatment – after HDC, before ASCR | Died 7 days after event |
| 11 | 16 |
Headache 3 metastases in CT |
No therapy | CR, during immunotherapy | Died of disease 3 months after event |
| 12 | 14 |
No symptoms; mild headache on a day of planned CT Tumour on CT – routine screening |
Surgery, chemotherapy, radiotherapy | CR: during immunotherapy | Alive, 2nd CNS relapse after 9 months |
| 13 | 20 |
Headache, vomiting Infiltration of meninges in MRI, NBL cells in cerebrospinal fluid |
Chemotherapy, radiotherapy | CR; 6 months after end of immunotherapy | Died of disease progression |
Dx diagnosis, NBL neuroblastoma, CNS central nervous system, CT computed tomography, RTX radiotherapy, CR complete remission, PR partial remission, MRD minimal residual disease, MRI magnetic resonance imaging