Nonmeningeal Extramedullary Relapse in Leukemia

Nonmeningeal, symptomatic, extramedullary, leukemic relapse occurred in four patients. The sites of leukemic involvement were bone, skin, head of pancreas, gallbladder, and pericardium. Three of the patients had acute lymphoblastic leukemia, and one had chronic granulocytic leukemia. Two of the three patients with acute lymphoblastic leukemia relapsed while receiving maintenance therapy; the third patient relapsed five years after therapy was discontinued. In two of the patients, full hematologic relapse and death occurred a few months after extramedullary relapse. To forestall such relapse, a more aggressive and prolonged program of antileukemic therapy—long after hematologic remission—may be necessary.