Tailored central nervous system-directed treatment strategy for isolated CNS recurrence of adult acute myeloid leukemia.
OBJECTIVE
The aim of this report was to investigate the tailored treatment strategies for isolated central nervous system (CNS) recurrence in adult patients with acute myeloid leukemia (AML).


METHODS
Isolated CNS recurrence was documented in 34 patients: there were 18, 6, and 10 patients with meningeal involvement type (type A), cranial nerve palsy type (type B), and myeloid sarcoma type (type C), respectively. For patients with type A, intrathecal chemotherapy was the predominant strategy. For type B, systemic HD-Ara-C with four cycles was the main treatment. For type C, cranial irradiation or craniospinal irradiation was adopted and two cycles of HD-Ara-C were given after the irradiation.


RESULTS
The 5-year cumulative incidence of CNS recurrence was 12.8%. There was a significantly higher WBC count (32.6∼60.8 × 10(9)/l) in patients at first diagnosis who developed CNS recurrence (all of the three types) compared with patients with no CNS recurrence (10.1 × 10(9)/l) (P = 0.005). We found that a significantly more patients with AML-M5 and 11q23 abnormalities developed CNS recurrence in type A (P < 0.001, 0.005). Twenty-four out of 34 patients (70.6%) with CNS recurrence achieved CNS complete remission at a median of 58 days (range, 30-120). The 3-year disease-free survival and overall survival estimates for all CNS recurrence patients were 21.6 and 25.3%, respectively.


CONCLUSIONS
This report indicates that the tailored CNS-directed strategy is an effective modality to treat CNS recurrence in adult AML, but further studies are needed to improve the long-term survival.
Changcheng
C
Zheng
Xin
X
Liu
Weibo
W
Zhu
Xiaoyan
X
Cai
Jingsheng
J
Wu
Zimin
Z
Sun
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002490:Central Nervous System / Q000187:drug effects / Q000473:pathology* / Q000528:radiation effects; D016543:Central Nervous System Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D012189:Retrospective Studies
Acute myeloid leukemia; Central nervous system recurrence; High-dose chemotherapy; Intrathecal; Irradiation