title: Detection of occult cerebrospinal fluid involvement during maintenance therapy identifies a group of children with acute lymphoblastic leukemia at high risk for relapse.
abstract: We aimed at assessing the clinical significance of the levels of acute lymphoblastic leukemia (ALL) cells in samples of cerebrospinal fluid (CSF) during therapy. We studied 990 CSF samples from 108 patients, at the time of diagnosis (108) and at each time of intrathecal therapy (882). The proportions of leukemic cells in CSF samples were assessed by flow cytometry (FCM). Patients with central nervous system (CNS) involvement at diagnosis (FCM+) showed predominantly a T-ALL, and higher percentages of known negative prognostic factors: high risk group, higher white blood cell counts, normal karyotype, and the BCR-ABL fusion gene. No differences in relapse free survival (RFS) and overall survival (OS) were observed between FCM+ versus FCM- at diagnosis. Patients with CNS involvement during therapy showed significantly older age, and higher frequencies of T-cell leukemia. We found a significantly higher RFS in patients with FCM+ during therapy. The detection of subclinical CNS disease by FCM during maintenance was associated with significantly lower 3-years RFS and 3-years OS. A sensitive methodology like FCM can be applied for a close follow-up of the levels of ALL in CFS samples, and may identify a group of patients at high risk for relapse.
authors.affiliation: Servicio de Oncohematología, Hospital Universitario Niño Jesús, Madrid, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Martínez-Laperche
authors.forename: Ana M
authors.initials: AM
authors.lastname: Gómez-García
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Lassaletta
authors.forename: Cristina
authors.initials: C
authors.lastname: Moscardó
authors.forename: José L
authors.initials: JL
authors.lastname: Vivanco
authors.forename: Javier
authors.initials: J
authors.lastname: Molina
authors.forename: José L
authors.initials: JL
authors.lastname: Fuster
authors.forename: José M
authors.initials: JM
authors.lastname: Couselo
authors.forename: José Sánchez
authors.initials: JS
authors.lastname: de Toledo
authors.forename: Encarnación
authors.initials: E
authors.lastname: Bureo
authors.forename: Luis
authors.initials: L
authors.lastname: Madero
authors.forename: Manuel
authors.initials: M
authors.lastname: Ramírez
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007278:Injections, Spinal; D060046:Maintenance Chemotherapy; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000556:secondary; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis