The clinical value of follow-up examinations in childhood T-cell acute lymphoblastic leukemia and T-cell non-Hodgkin's lymphoma.
BACKGROUND
The aim of this study was to evaluate the value of follow-up investigations of T-cell acute lymphoblastic leukemia (T-ALL) and T-cell non-Hodgkin's lymphoma (T-NHL), including cerebrospinal fluid (CSF) examination, bone marrow (BM) aspiration, peripheral blood (PB) count, serum lactate dehydrogenase (LDH) and chest X-rays in patients with an initial mediastinal enlargement.


METHODS
We reviewed clinical records of all T-ALL patients from 1987 to 2002 and all T-NHL patients from 1977 to 2002, seen at a single institution.


RESULTS
Of 48 T-ALL patients, 15 suffered from a relapse, 6 (40%) were asymptomatic at the time of relapse. T-ALL (13/30) with mediastinal enlargement at first diagnosis relapsed versus 2/16 of those without mediastinal enlargement. However, at relapse, only one patient had a mediastinal mass, which in addition was symptomatic. Of 39 T-NHL patients, 6 patients relapsed. Forty percent of relapsed T-ALL and 17% of relapsed T-NHL were asymptomatic. The seven asymptomatic relapses were detected by CSF (n = 4), BM (n = 2) or blood count (n = 1) examinations. All T-ALL and T-NHL patients with a mediastinal relapse were symptomatic.


CONCLUSIONS
This study suggests that routine CSF examinations during treatment can detect relapses of T-ALL and T-NHL before onset of symptoms, which might be of clinical value. Relapses are rarely detected by BM or blood examinations and whether this translates in a clinical benefit is unlikely. Routine chest X-rays are not useful.
Huang
L
L
Department of Pediatric Hemato-Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Lequin
M
M
Pieters
R
R
van den Heuvel-Eibrink
M M
MM
D000293:Adolescent; D014408:Biomarkers, Tumor / Q000097:blood; D001856:Bone Marrow Examination; D002648:Child; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine; D019468:Disease Management; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007770:L-Lactate Dehydrogenase / Q000097:blood; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D017254:Leukemic Infiltration / Q000175:diagnosis / Q000453:epidemiology; D016399:Lymphoma, T-Cell / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D008482:Mediastinum / Q000473:pathology; D011379:Prognosis; D011859:Radiography; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies
D014408:Biomarkers, Tumor; D007770:L-Lactate Dehydrogenase