CNS blast crisis of chronic myelogenous leukemia in a patient with a 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 Jun;83(6):401-2. doi: 10.1007/s00277-003-0829-4. Epub 2003 Dec 12.


Imatinib mesylate (STI571) is a very effective treatment option for Ph(+) chronic myeloid leukemia (CML) in chronic phase. Secondary treatment failures have mostly been observed in patients with advanced stages of disease. We report the case of a patient who unexpectedly experienced blast crisis of the central nervous system although having achieved complete cytogenetic remission in the bone marrow. The levels of STI571 and its metabolite N-desmethyl STI were 40-fold lower in the cerebral spine fluid than in plasma. The risk of CNS disease has to be kept in mind when patients with CML in chronic phase who are at an increased risk for blastic transformation are treated with imatinib mesylate.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / cerebrospinal fluid*
  • Benzamides
  • Blast Crisis / genetics*
  • Bone Marrow / pathology*
  • Central Nervous System / pathology*
  • Female
  • Humans
  • Imatinib Mesylate
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / cerebrospinal fluid
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / drug therapy
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / genetics
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / pathology*
  • Middle Aged
  • Piperazines / administration & dosage
  • Piperazines / cerebrospinal fluid*
  • Pyrimidines / administration & dosage
  • Pyrimidines / cerebrospinal fluid*
  • Remission Induction


  • Antineoplastic Agents
  • Benzamides
  • Piperazines
  • Pyrimidines
  • Imatinib Mesylate