No role for cerebrospinal fluid myelin basic protein levels in patients treated for childhood acute lymphoblastic leukemia.
BACKGROUND
Central nervous system prophylaxis of childhood acute lymphoblastic leukemia has dropped rates of relapses but has been associated with neurotoxicity and imaging abnormalities. Predictors of neurotoxicity are lacking, because of inconsistency between clinical symptoms and imaging. Some have suggested that cerebrospinal fluid myelin basic protein (MBP) levels to be of potential interest. A retrospective analysis of MBP levels in correlation with clinical and radiologic data is presented.


METHODS
MBP levels obtained at the time of intrathecals, charts, and neuroradiology reports were retrospectively analyzed. Academic achievement data were obtained from phone contacts with patients and families.


RESULTS
We retrieved 1248 dosages of MBP in 83 patients, 381 neurologic examinations in 34 patients and 69 neuroradiologic investigations in 27 patients. Fifty-two patients had abnormal MBP levels. Radiologic anomalies were present in 47% of those investigated, 14% of them having school difficulties. Proportions of patients with school difficulties in the groups with abnormal MBP levels but no radiologic anomalies or with no radiologic investigations were 0% and 3%, respectively, which was lower than in the group of patients with normal MBP levels (100%, 22%, and 5%, respectively).


CONCLUSIONS
Notwithstanding the retrospective character of our study, we conclude that there is limited usefulness of systematic dosage of MBP as indicator of treatment-induced neurotoxicity in acute lymphoblastic leukemia patients.
Diezi
Manuel
M
Hematology-Oncology Unit, Department of Pediatrics, University Hospital, Lausanne, Switzerland. manuel.diezi@chuv.ch
Garcia
Emma
E
Weid
Nicolas von der
Nv
Beck-Popovic
Maja
M
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D001921:Brain / Q000473:pathology; D016543:Central Nervous System Neoplasms / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000134:cerebrospinal fluid* / Q000209:etiology; D003131:Combined Modality Therapy / Q000009:adverse effects; D016371:Cranial Irradiation; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007278:Injections, Spinal; D008297:Male; D004676:Myelin Basic Protein / Q000134:cerebrospinal fluid*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000134:cerebrospinal fluid* / Q000473:pathology / Q000628:therapy*
D004676:Myelin Basic Protein