Meningeal involvement as first manifestation of acute myeloblastic transformation in chronic granulocytic leukemia.

I N CHRONIC GRANULOCYTIC LEUKEMIA neurologic manifestations due to leukemic infiltration of the central nervous system occur uncommonly.’ In acute lymphoblastic leukemia, on the other hand, diffuse leukemic infiltration of the lepto-meninges is frequent and must be differentiated from neurologic involvement due to infection, hemorrhage, or drug toxicity.2 \Vhen acute myeloblastic transformation of chronic granulocytic leukemia occurs, intracranial complications usually manifest as cerebrovascular hemorrhage, but may represent myeloblastic infiltration of the meninges.3 To our knowledge meningeal leukemia as the single clinical feature of an acute “blastic” phase of chronic granulocytic leukemia has not been previously reported. Tile purpose of the present paper is to document the course of a patient with chronic granulocytic leukemia who developed myeloblastic involvement of the central nervous system three months before acute myeloblastic transformation was manifested systemically. The diagnosis of meningeal leukemia was confirmed by tile demonstration in the cerebrospinal fluid of myeloblasts containing the Philadelphia (Ph1) chromosome.