{
  "abstract": "BackgroundCentral nervous system-predominant pediatric B-cell acute lymphoblastic leukemia (B-ALL) may present without peripheral blood abnormalities, and corticosteroid exposure can cause false-negative CSF cytomorphology.Case presentationA 5-year-and-7-month-old boy presented with recurrent seizures and cranial nerve deficits. Initial peripheral blood smears and CSF examinations were blast-negative. The interval between symptom onset and definitive diagnosis was 8 months; whether early symptoms were leukemia-attributable remains uncertain. In December 2019, repeated lumbar puncture revealed CSF pleocytosis (89 × 106/L) with suspicious blasts. Bone marrow showed 81.5% blasts; flow cytometry confirmed B-lymphoid phenotype. CSF flow cytometry confirmed CNS3 status. KRAS G12 V (10.2% VAF) was detected. Peripheral blood remained blast-negative throughout. He achieved complete remission (morphological blasts <5%; MRD <0.01%) on the CCCG-ALL-2015 HR protocol. In March 2021, he developed isolated bone marrow relapse (morphological blasts 56%; MRD 50%) with negative CSF. Sequential CD19/CD22 CAR T therapy induced sustained remission. At the last follow-up (52 months post-CAR T), MRD remained below detection.ConclusionsCNS-predominant B-ALL may present with recurrent seizures despite normal peripheral blood. Repeated CSF analysis and flow cytometry are essential when cytomorphology is negative. Sequential CD19/CD22 CAR T achieved durable remission in relapsed B-ALL with prior CNS involvement.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Clinical Laboratory, Shenzhen Children's Hospital, Affiliated with Shantou University Medical College, Shenzhen, Guangdong, China",
    "Department of Clinical Laboratory Medicine, The People’s Hospital of Longhua, Shenzhen, Guangdong, China"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Ke Cao"
    },
    {
      "affs": [
        0
      ],
      "name": "Yan Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Xiaojuan Luo"
    },
    {
      "affs": [
        1
      ],
      "name": "Xueyan Chen"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0n3k65pa98wbx.bib",
  "cited_by": 0,
  "doi": "10.3389/fped.2026.1996188",
  "fulltext_url": "https://www.frontiersin.org/articles/10.3389/fped.2026.1996188/full",
  "id": "0n3k65pa98wbx",
  "issns": [
    "2296-2360"
  ],
  "landing_url": "https://doi.org/10.3389/fped.2026.1996188",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RJ1-570"
    ]
  ],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-12",
  "publisher": "Frontiers Media S.A.",
  "ris": "https://research.draconitic.com/paper/0n3k65pa98wbx.ris",
  "sources": [
    {
      "first_seen": "2026-11-12T14:58:36Z",
      "native_id": "129d9d4f34284bce9a2d0d5928cfdb92",
      "source": "doaj",
      "url": "https://doi.org/10.3389/fped.2026.1996188"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:RJ1-570",
      "subfield": "reproductive-child"
    }
  ],
  "title": "Case Report: Pediatric B-cell acute lymphoblastic leukemia presenting with recurrent seizures and persistent peripheral blood blast negativity",
  "title_text": "Case Report: Pediatric B-cell acute lymphoblastic leukemia presenting with recurrent seizures and persistent peripheral blood blast negativity",
  "type": "peer-reviewed",
  "updated_at": "2026-11-13T15:20:57Z",
  "url": "https://research.draconitic.com/paper/0n3k65pa98wbx",
  "venue": "Frontiers in Pediatrics",
  "versions": []
}