Table 3 CNS relapse presentation, treatment, and course of disease
Pt | Time from diagnosis to CNS relapse (months) | Relapse presentation | Relapse therapy | Disease status and time to relapse | Disease course after relapse |
|---|---|---|---|---|---|
1 | 5 | Facial nerve palsy, strabismus Tumour in CT NBL cells in CSF and in removed tumour | Surgery, RTX, chemotherapy, intrathecal chemotherapy | CR; on treatment after induction and surgery | Local progression 6Â months from relapse, death 7Â months from relapse |
2 | 6 | Intracranial bleeding No tumour in CT NBL cells in removed tumour | Surgery | CR; on treatment – before HDC | Died 2 weeks after event |
3 | 5 | Accidental diagnosis CT: infiltration of meninges, bleeding into the tumour | Chemotherapy, intrathecal chemotherapy | PR; on treatment - after induction | Died 3Â weeks after event bleeding into tumour |
4 | 12 | Intracranial bleeding No radiological symptoms NBL in postmortem examination | No therapy | CR; on treatment - therapy of MRD | Died 5Â days after event |
5 | 8 | Headache, nausea, vomiting Tumour in CT NBL cells in removed tumour | Surgery, radiotherapy, chemotherapy, 13 cis RA | CR; after end of treatment | CR in CNS; disseminated bone relapse 39Â months after relapse; no 3rd line treatment. Died of disease |
6 | 15 | Facial nerve palsy | Chemotherapy | PR; on treatment – therapy of MRD | Local progression and death 3 months after relapse |
7 | 26 | Headache, nausea, vomiting Tumour in CT | Chemotherapy, radiotherapy, no surgery (tumour regression on chemotherapy) | CR; after end of treatment | Alive in CR > 9 years after relapse |
8 | 8 | Intracranial bleeding No radiological symptoms NBL in postmortem examination | No therapy | CR; on treatment – after radiotherapy | Died 2 days after event |
9 | 20 | Headache, nausea, vomiting 2 tumours in CT NBL cells in removed tumour | Surgery, chemotherapy, radiotherapy, ibritumomab | CR; 3Â months after end of treatment | Alive in CR, 2,5Â years after relapse |
10 | 8 | Intracranial bleeding No radiological symptoms NBL in postmortem examination | No therapy | PR; on treatment – after HDC, before ASCR | Died 7 days after event |
11 | 16 | Headache 3 metastases in CT | No therapy | CR, during immunotherapy | Died of disease 3Â months after event |
12 | 14 | No symptoms; mild headache on a day of planned CT Tumour on CT – routine screening | Surgery, chemotherapy, radiotherapy | CR: during immunotherapy | Alive, 2nd CNS relapse after 9 months |
13 | 20 | Headache, vomiting Infiltration of meninges in MRI, NBL cells in cerebrospinal fluid | Chemotherapy, radiotherapy | CR; 6Â months after end of immunotherapy | Died of disease progression |