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Hematologic Malignancies • Pediatric Hematology/Oncology • Medical Oncology • Leukemia • Internal Medicine • ALL • Hematology
Would you offer intensive CNS prophylaxis to Ph negative B-ALL patients who have possible mandibular nerve involvement on MRI face?
The patient presented with a numb chin, more to the right of his face; an MRI did report mandibular nerve opacity, which is non-specific per neuro-radiology; opacity was in the left mandibular nerve. CSF has been negative for malignant cells. His chin numbness did improve with course 1 of CALGB 10403. Does the patient need CNS prophylaxis as CNS1 or CNS3?
Answer from: Medical Oncologist at Academic Institution
I would be inclined to treat this patient according to the CNS3 schedule of CNS-directed prophylaxis.Mental nerve neuropathy (or "numb chin syndrome," a rather pedestrian-sounding term for which I cannot take credit) can be a sign of leptomeningeal disease, presumably due to more focal involvement a...
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