PMC8287827_01
Detection of meningeal involvement by APL cells. (A1-2) Promyelocytic leukemia cells in CSF; (B1a, 1b) Contrast MRI before venetoclax treatment on July 9, 2020, (B2a, 2b) Contrast MRI during venetoclax treatment on September 17, 2020; (B3a, 3b) Contrast MRI during venetoclax treatment on November 11, 2020.
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CSF pressure of 300 mmH2O, 150 nucleated cells/muL (normal reference value <8/muL), 15% neutrophils, 60% lymph, and 25% mononuclear. CSF exfoliation cytology found abnormal promyelocytic leukemia cells ( Figures 1-A1, 2 ). CSF leukemia cells and immunological remission of the bone marrow was also maintained ( Figure 2 ). CSF leukemic cells continued to be negative by flow cytometry, but a repeat MRI of the brain still suggested possible localized meningeal involvement ( Figures 1-B1-3 ).
Trends of APL cells counts in CSF.
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CSF pressure of 300 mmH2O, 150 nucleated cells/muL (normal reference value <8/muL), 15% neutrophils, 60% lymph, and 25% mononuclear. CSF exfoliation cytology found abnormal promyelocytic leukemia cells ( Figures 1-A1, 2 ). CSF leukemia cells and immunological remission of the bone marrow was also maintained ( Figure 2 ). CSF leukemic cells continued to be negative by flow cytometry, but a repeat MRI of the brain still suggested possible localized meningeal involvement ( Figures 1-B1-3 ). This patient is still on ongoing venetoclax therapy and has maintained complete remission of CNS for 8 months ( Figure 2 ).
Detection of venetoclax in plasma and CSF by mass spectrometry. (A) Plasma venetoclax valley concentration; (B) Venetoclax concentration in the patient's CSF; (C) Background concentration of venetoclax in the patient's CSF before starting venetoclax.
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CSF leukemia cells and immunological remission of the bone marrow was also maintained ( Figure 2 ). CSF leukemic cells continued to be negative by flow cytometry, but a repeat MRI of the brain still suggested possible localized meningeal involvement ( Figures 1-B1-3 ). The concentration of venetoclax in CSF was approximately 1/300 of that in the plasma trough concentration ( Figure 3 ).