title: Incidence and risk factors for central nervous system relapse in children and adolescents with acute lymphoblastic leukemia.
abstract: BACKGROUND
  Despite all the advances in the treatment of childhood acute lymphoblastic leukemia, central nervous system relapse remains an important obstacle to curing these patients. This study analyzed the incidence of central nervous system relapse and the risk factors for its occurrence in children and adolescents with acute lymphoblastic leukemia.
  
  
  METHODS
  This study has a retrospective cohort design. The studied population comprised 199 children and adolescents with a diagnosis of acute lymphoblastic leukemia followed up at Hospital das Clinicas, Universidade Federal de Minas Gerais (HC-UFMG) between March 2001 and August 2009 and submitted to the Grupo Brasileiro de Tratamento de Leucemia da Infância - acute lymphoblastic leukemia (GBTLI-LLA-99) treatment protocol.
  
  
  RESULTS
  The estimated probabilities of overall survival and event free survival at 5 years were 69.5% (± 3.6%) and 58.8% (± 4.0%), respectively. The cumulative incidence of central nervous system (isolated or combined) relapse was 11.0% at 8 years. The estimated rate of isolated central nervous system relapse at 8 years was 6.8%. In patients with a blood leukocyte count at diagnosis ≥ 50 x 10(9)/L, the estimated rate of isolated or combined central nervous system relapse was higher than in the group with a count < 50 x 10(9)/L (p-value = 0.0008). There was no difference in cumulative central nervous system relapse (isolated or combined) for the other analyzed variables: immunophenotype, traumatic lumbar puncture, interval between diagnosis and first lumbar puncture and place where the procedure was performed.
  
  
  CONCLUSIONS
  These results suggest that a leukocyte count > 50 x 10(9)/L at diagnosis seems to be a significant prognostic factor for a higher incidence of central nervous system relapse in childhood acute lymphoblastic leukemia.
authors: Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, MG, Brazil.
authors: Camila Silva Peres
authors: CS
authors: Cancela
authors: Mitiko
authors: M
authors: Murao
authors: Marcos Borato
authors: MB
authors: Viana
authors: Benigna Maria
authors: BM
authors: de Oliveira
keywords: Adolescent; Central nervous system neoplasms/cerebrospinal fluid; Central nervous system neoplasms/pathology; Child; Leukemia, lymphoid/epidemiology Spinal puncture; Prognosis; Recurrence; Risk factors