Neuroleukemiosis: An unusual cause of peripheral neuropathy

Chandan G. Reddy, Michelle M Mauermann, Benjamin M. Solomon, Michael D. Ringler, Nivedita U. Jerath, Kebede Begna, Kimberly K. Amrami, Robert J. Spinner

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Leukemia may initially present as a peripheral neuropathy, leading to a delay in diagnosis. Leukemic infiltration of peripheral nerves, or neuroleukemiosis (NL), is exceedingly rare, with no established diagnostic or therapeutic guidelines. Five cases are presented. All patients were men with a median age of 68 years (range 4672). Three patients had acute myeloid leukemia (AML) and two had chronic lymphocytic leukemia (CLL). In two patients, leukemia presented with peripheral nerve involvement and both were found to have positive cerebrospinal fluid (CSF) cytology, making the diagnosis AML, despite negative bone marrow and peripheral smear. All patients had painful, progressive, motor and sensory deficits. Clinical patterns were mononeuropathy (n 1), multiple mononeuropathies (n 1) and plexopathy (n 3). Magnetic resonance imaging (MRI) detected mass lesions in 4/5 cases, with avid fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) useful in all of these for following clinical disease progression. Three cases of nerve biopsy were performed, two of which were diagnostic of leukemic infiltration. Radiation treatment rapidly relieved pain in patients with mass lesions, in combination with chemotherapy. Four patients had disease relapse, four systemic and one also in peripheral nerves. These cases are discussed in the context of the broader literature.

Original languageEnglish (US)
Pages (from-to)2405-2411
Number of pages7
JournalLeukemia and Lymphoma
Volume53
Issue number12
DOIs
StatePublished - Dec 2012

Fingerprint

Peripheral Nervous System Diseases
Leukemic Infiltration
Peripheral Nerves
Mononeuropathies
Acute Myeloid Leukemia
Leukemia
B-Cell Chronic Lymphocytic Leukemia
Combination Drug Therapy
Positron-Emission Tomography
Cell Biology
Cerebrospinal Fluid
Disease Progression
Bone Marrow
Magnetic Resonance Imaging
Guidelines
Radiation
Biopsy
Recurrence
Pain
Therapeutics

Keywords

  • Acute myeloid leukemia
  • Chronic lymphocytic leukemia
  • Granulocytic sarcoma
  • Neuroleukemiosis

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Reddy, C. G., Mauermann, M. M., Solomon, B. M., Ringler, M. D., Jerath, N. U., Begna, K., ... Spinner, R. J. (2012). Neuroleukemiosis: An unusual cause of peripheral neuropathy. Leukemia and Lymphoma, 53(12), 2405-2411. https://doi.org/10.3109/10428194.2012.691480

Neuroleukemiosis : An unusual cause of peripheral neuropathy. / Reddy, Chandan G.; Mauermann, Michelle M; Solomon, Benjamin M.; Ringler, Michael D.; Jerath, Nivedita U.; Begna, Kebede; Amrami, Kimberly K.; Spinner, Robert J.

In: Leukemia and Lymphoma, Vol. 53, No. 12, 12.2012, p. 2405-2411.

Research output: Contribution to journalArticle

Reddy, CG, Mauermann, MM, Solomon, BM, Ringler, MD, Jerath, NU, Begna, K, Amrami, KK & Spinner, RJ 2012, 'Neuroleukemiosis: An unusual cause of peripheral neuropathy', Leukemia and Lymphoma, vol. 53, no. 12, pp. 2405-2411. https://doi.org/10.3109/10428194.2012.691480
Reddy, Chandan G. ; Mauermann, Michelle M ; Solomon, Benjamin M. ; Ringler, Michael D. ; Jerath, Nivedita U. ; Begna, Kebede ; Amrami, Kimberly K. ; Spinner, Robert J. / Neuroleukemiosis : An unusual cause of peripheral neuropathy. In: Leukemia and Lymphoma. 2012 ; Vol. 53, No. 12. pp. 2405-2411.
@article{77bae4e02bbb41ad88c11cde7e6b1e4e,
title = "Neuroleukemiosis: An unusual cause of peripheral neuropathy",
abstract = "Leukemia may initially present as a peripheral neuropathy, leading to a delay in diagnosis. Leukemic infiltration of peripheral nerves, or neuroleukemiosis (NL), is exceedingly rare, with no established diagnostic or therapeutic guidelines. Five cases are presented. All patients were men with a median age of 68 years (range 4672). Three patients had acute myeloid leukemia (AML) and two had chronic lymphocytic leukemia (CLL). In two patients, leukemia presented with peripheral nerve involvement and both were found to have positive cerebrospinal fluid (CSF) cytology, making the diagnosis AML, despite negative bone marrow and peripheral smear. All patients had painful, progressive, motor and sensory deficits. Clinical patterns were mononeuropathy (n 1), multiple mononeuropathies (n 1) and plexopathy (n 3). Magnetic resonance imaging (MRI) detected mass lesions in 4/5 cases, with avid fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) useful in all of these for following clinical disease progression. Three cases of nerve biopsy were performed, two of which were diagnostic of leukemic infiltration. Radiation treatment rapidly relieved pain in patients with mass lesions, in combination with chemotherapy. Four patients had disease relapse, four systemic and one also in peripheral nerves. These cases are discussed in the context of the broader literature.",
keywords = "Acute myeloid leukemia, Chronic lymphocytic leukemia, Granulocytic sarcoma, Neuroleukemiosis",
author = "Reddy, {Chandan G.} and Mauermann, {Michelle M} and Solomon, {Benjamin M.} and Ringler, {Michael D.} and Jerath, {Nivedita U.} and Kebede Begna and Amrami, {Kimberly K.} and Spinner, {Robert J.}",
year = "2012",
month = "12",
doi = "10.3109/10428194.2012.691480",
language = "English (US)",
volume = "53",
pages = "2405--2411",
journal = "Leukemia and Lymphoma",
issn = "1042-8194",
publisher = "Informa Healthcare",
number = "12",

}

TY - JOUR

T1 - Neuroleukemiosis

T2 - An unusual cause of peripheral neuropathy

AU - Reddy, Chandan G.

AU - Mauermann, Michelle M

AU - Solomon, Benjamin M.

AU - Ringler, Michael D.

AU - Jerath, Nivedita U.

AU - Begna, Kebede

AU - Amrami, Kimberly K.

AU - Spinner, Robert J.

PY - 2012/12

Y1 - 2012/12

N2 - Leukemia may initially present as a peripheral neuropathy, leading to a delay in diagnosis. Leukemic infiltration of peripheral nerves, or neuroleukemiosis (NL), is exceedingly rare, with no established diagnostic or therapeutic guidelines. Five cases are presented. All patients were men with a median age of 68 years (range 4672). Three patients had acute myeloid leukemia (AML) and two had chronic lymphocytic leukemia (CLL). In two patients, leukemia presented with peripheral nerve involvement and both were found to have positive cerebrospinal fluid (CSF) cytology, making the diagnosis AML, despite negative bone marrow and peripheral smear. All patients had painful, progressive, motor and sensory deficits. Clinical patterns were mononeuropathy (n 1), multiple mononeuropathies (n 1) and plexopathy (n 3). Magnetic resonance imaging (MRI) detected mass lesions in 4/5 cases, with avid fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) useful in all of these for following clinical disease progression. Three cases of nerve biopsy were performed, two of which were diagnostic of leukemic infiltration. Radiation treatment rapidly relieved pain in patients with mass lesions, in combination with chemotherapy. Four patients had disease relapse, four systemic and one also in peripheral nerves. These cases are discussed in the context of the broader literature.

AB - Leukemia may initially present as a peripheral neuropathy, leading to a delay in diagnosis. Leukemic infiltration of peripheral nerves, or neuroleukemiosis (NL), is exceedingly rare, with no established diagnostic or therapeutic guidelines. Five cases are presented. All patients were men with a median age of 68 years (range 4672). Three patients had acute myeloid leukemia (AML) and two had chronic lymphocytic leukemia (CLL). In two patients, leukemia presented with peripheral nerve involvement and both were found to have positive cerebrospinal fluid (CSF) cytology, making the diagnosis AML, despite negative bone marrow and peripheral smear. All patients had painful, progressive, motor and sensory deficits. Clinical patterns were mononeuropathy (n 1), multiple mononeuropathies (n 1) and plexopathy (n 3). Magnetic resonance imaging (MRI) detected mass lesions in 4/5 cases, with avid fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) useful in all of these for following clinical disease progression. Three cases of nerve biopsy were performed, two of which were diagnostic of leukemic infiltration. Radiation treatment rapidly relieved pain in patients with mass lesions, in combination with chemotherapy. Four patients had disease relapse, four systemic and one also in peripheral nerves. These cases are discussed in the context of the broader literature.

KW - Acute myeloid leukemia

KW - Chronic lymphocytic leukemia

KW - Granulocytic sarcoma

KW - Neuroleukemiosis

UR - http://www.scopus.com/inward/record.url?scp=84868340682&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84868340682&partnerID=8YFLogxK

U2 - 10.3109/10428194.2012.691480

DO - 10.3109/10428194.2012.691480

M3 - Article

C2 - 22571477

AN - SCOPUS:84868340682

VL - 53

SP - 2405

EP - 2411

JO - Leukemia and Lymphoma

JF - Leukemia and Lymphoma

SN - 1042-8194

IS - 12

ER -