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Thomas Bradford Gillette, Andrew Stacey; Relapse of Leukemia in the Anterior Segment of the Eye: A systematic review. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5577. doi: https://doi.org/.
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To describe the risk factors, presentation features, and clinical characteristics associated with the development of leukemic relaps in the anterior segment of the eye.
A systematic review of all reported cases of anterior segment leukemic relapse was conducted following the “Preferred Reporting Items for Systematic Review and Meta-analysis” (PRISMA) guidelines. Four separate databases were searched (PubMed, Medline, Embase, Cochrane). Cases were included in the review if they described a patient with biopsy proven ocular leukemic relapse confined to the anterior segment. Clinical information from the report was used in the analysis, but reports were not excluded if they did not contain specific clinical details.
A total of 29 cases were included in the study. All reported a biopsy which demonstrated the leukemic relapse. 69% (20) of these relapses had no evidence of bone marrow (BM) or CNS relapse at the time of biopsy. Of these 20 cases, 35% (7) went on to develop BM or CNS relapse after normal BM and CNS testing at the time of biopsy. 14 cases had a diagnosis of acute lymphoblastic leukemia (ALL) and 5 had a diagnosis of acute myeloid leukemia (AML). 31% (9) of the 29 cases had evidence of either BM or CNS relapse or both at time of biopsy. Of those with positive systemic screening, 4 of these cases had a diagnosis of acute lymphoblastic leukemia (ALL) and 3 had a diagnosis of acute myeloid leukemia (AML). 4 of these cases resulted in death, 3 were still alive, and 2 had an unknown outcome.
A leukemic relapse should be considered in any patient with a history of acute leukemia and an unexplained anterior segment inflammation.. Importantly, one cannot rely on systemic studies (LP, MRI, BMB) to rule out leukemic relapse as a cause of anterior ocular symptoms in these patients as a large percentage of patients with biopsy proven anterior segment ocular leukemic relapse were found to have normal systemic studies. Furthermore, many of these patients go on to develop BM or CNS relapse. The acute leukemias appear to be uniquely capable of this type of relapse, with ALL appearing far more frequently than AML. Relapse has occurred even in the presence of CNS prophylaxis at the time of induction chemotherapy.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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