Biological, clinical, and radiologic characteristics of patients at diagnosis of CNSi and outcome on ibrutinib
| . | Patient 1 . | Patient 2 . | Patient 3 . | Patient 4 . |
|---|---|---|---|---|
| Age (y)/sex | 58/M | 75/M | 63/M | 68/F |
| Prior lines of therapy for CLL | 8 | 4 | 2 | 0 |
| Binet stage at CNSi | C | B | C | A |
| Lymphocytosis at CNSi (G/L) | 20 | 0.9 | 245 | 5.5 |
| Progressive disease at CNSi diagnosis | Yes | No | Yes | No |
| Del17p | Yes | Yes | No | Yes |
| Neurologic symptoms | Dysautonomy | Headache and cognitive disturbance | Cerebellar syndrome and aphasia confusion | Visual loss |
| Last neuroimaging before ibrutinib initiation | Nodular enhancement of left parietal lobe with not specific periventricular T2 hyperintensities | Normal | NA | Thickening of optic nerves and chiasma. FLAIR hyperintensities |
| with nodular lesion of internal occipito-temporal region | ||||
| CSF cellularity (μ−1) | 22 | 231 | 176 | 52 |
| CSF involvement | 93% monoclonal B cells | 78% monoclonal B cells | 96% monoclonal B cells | 0.7% CLL cells and 91% CD4+ T cells |
| Red cells (μ−1) | 0 | 0 | 0 | 0 |
| Proteinorachia (g/L) | 0.53 | 1.42 | 0.39 | 1.78 |
| Delay between neurologic manifestations and CNSi diagnosis (mo) | 19 | 0 | 1 | 3 |
| Intra-CSF chemotherapy In another line of treatment | ||||
| Yes | Yes | Yes | No | |
| Response to ibrutinib | ||||
| CSF evaluation | CR | CR | CR | CR |
| Neurologic symptoms | Not evaluable | CR | CR | CR |
| Hematologic disease | PR with lymphocytosis | CR | CR | CR |
| Neuroimaging | Normalization | — | — | Near normalization |
| Follow up (mo) | 9 | 14 | 8 | 9 |
| Status at last follow up | Dead in CR | Alive in CR | Alive in CR | Alive in CR |
| (stroke) |
| . | Patient 1 . | Patient 2 . | Patient 3 . | Patient 4 . |
|---|---|---|---|---|
| Age (y)/sex | 58/M | 75/M | 63/M | 68/F |
| Prior lines of therapy for CLL | 8 | 4 | 2 | 0 |
| Binet stage at CNSi | C | B | C | A |
| Lymphocytosis at CNSi (G/L) | 20 | 0.9 | 245 | 5.5 |
| Progressive disease at CNSi diagnosis | Yes | No | Yes | No |
| Del17p | Yes | Yes | No | Yes |
| Neurologic symptoms | Dysautonomy | Headache and cognitive disturbance | Cerebellar syndrome and aphasia confusion | Visual loss |
| Last neuroimaging before ibrutinib initiation | Nodular enhancement of left parietal lobe with not specific periventricular T2 hyperintensities | Normal | NA | Thickening of optic nerves and chiasma. FLAIR hyperintensities |
| with nodular lesion of internal occipito-temporal region | ||||
| CSF cellularity (μ−1) | 22 | 231 | 176 | 52 |
| CSF involvement | 93% monoclonal B cells | 78% monoclonal B cells | 96% monoclonal B cells | 0.7% CLL cells and 91% CD4+ T cells |
| Red cells (μ−1) | 0 | 0 | 0 | 0 |
| Proteinorachia (g/L) | 0.53 | 1.42 | 0.39 | 1.78 |
| Delay between neurologic manifestations and CNSi diagnosis (mo) | 19 | 0 | 1 | 3 |
| Intra-CSF chemotherapy In another line of treatment | ||||
| Yes | Yes | Yes | No | |
| Response to ibrutinib | ||||
| CSF evaluation | CR | CR | CR | CR |
| Neurologic symptoms | Not evaluable | CR | CR | CR |
| Hematologic disease | PR with lymphocytosis | CR | CR | CR |
| Neuroimaging | Normalization | — | — | Near normalization |
| Follow up (mo) | 9 | 14 | 8 | 9 |
| Status at last follow up | Dead in CR | Alive in CR | Alive in CR | Alive in CR |
| (stroke) |
FLAIR, fluid attenuated inversion recover; NA, not available.