Successfully Treated Isolated Ocular Relapse In An Adult With Philadelphia+Acute Lymphoblastic Leukemia During Complete Molecular Remission With Dasatinib

Erika Yamamoto

Purpose: To report a successfully treated case of solely ocular relapse in an adult with Philadelphia chromosome (Ph+) acute lymphoblastic leukemia (ALL) during complete molecular remission.

Methods: A 30-year-old woman, in the continuing complete molecular remission phase of Ph+ ALL with dasatinib, presented photophobia and decrease of vision in the right eye. She had undergone allogeneic hematopoietic stem cell transplantation from her HLA-matched brother. Ophthalmic examinations revealed hypopyon. Although there was no evidence of relapse in the blood, bone marrow or central nervous system, 2.0×10６ copies/μg RNA of minor-bcr/abl transcripts were amplified in aqueous humor using real-time quantitative reverse transcriptase-polymerase chain reaction assay that confirm the right eye as the isolated site of relapse in hematological remission of 22months. F317L mutation was detected by direct sequencing.

Results: Administration of radiation to the affected eye resulted in improvement of visual acuity from 20/40 to 20/15, anterior segment returned to an almost normal phenomenon and minor-bcr/abl transcripts in aqueous humor were undetectable.

Conclusions: Ocular involvement of the anterior chamber as the isolated site of relapse is a rare event in adult patients with Ph+ ALL. Even though the prognosis is mostly dependent on the stage of the disease at the time of relapsing ALL, the ocular relapse implied poor prognosis. Therefore, diagnostic anterior chamber paracentesis without delay and immediate radiation were effective to an anterior chamber infiltration and improved quality of vision during the continuous complete remission phase of Ph+ ALL in adults.