title: High sensitivity of flow cytometry improves detection of occult leptomeningeal disease in acute lymphoblastic leukemia and lymphoblastic lymphoma.
abstract: Conventional cytology (CC) of cerebrospinal fluid (CSF) fails to demonstrate malignant cells in up to 45 % of patients with acute lymphoblastic leukemia or lymphoblastic lymphoma (ALL/LL) in whom occult leptomeningeal disease is present. Flow cytometry (FCM) is considered more sensitive than CC, but clinical implications of CC negativity/CC positivity are not yet established. CSF samples from 38 adult patients with newly diagnosed ALL/LL were examined. Five (13 %) and nine (24 %) specimens were CC positive-FC positive (FCM(pos)/CC(pos)) and CC negative-FC positive (CC(neg)/FCM(pos)), respectively. The remaining 24 (63 %) samples were double negative (CC(neg)/FCM(neg)) (p = 0.001). CC(neg)/FCM(pos) patients showed a significantly shorter overall survival (OS) compared to CC(neg)/FCM(neg) ones. In multivariate analysis, the status of single FCM positivity was demonstrated to affect independently duration of OS (p = 0.005). In conclusion, FCM significantly improves detection of leptomeningeal occult localization in ALL/LL and appears to anticipate an adverse outcome. Further prospective studies on larger series are needed to confirm this preliminary observation.
authors.affiliation: Cattedra di Ematologia, Dipartimento di Biopatologia e Prevenzione, Università Tor Vergata, Roma, Italia, del.principe@med.uniroma2.it.
authors.forename: Maria Ilaria
authors.initials: MI
authors.lastname: Del Principe
authors.forename: Francesco
authors.initials: F
authors.lastname: Buccisano
authors.forename: Mariagiovanna
authors.initials: M
authors.lastname: Cefalo
authors.forename: Luca
authors.initials: L
authors.lastname: Maurillo
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Caprio
authors.forename: Fabio
authors.initials: F
authors.lastname: Di Piazza
authors.forename: Chiara
authors.initials: C
authors.lastname: Sarlo
authors.forename: Gottardo
authors.initials: G
authors.lastname: De Angelis
authors.forename: Maria
authors.initials: M
authors.lastname: Irno Consalvo
authors.forename: Daniela
authors.initials: D
authors.lastname: Fraboni
authors.forename: Giovanna
authors.initials: G
authors.lastname: De Santis
authors.forename: Concetta
authors.initials: C
authors.lastname: Ditto
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Postorino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sconocchia
authors.forename: Giovanni
authors.initials: G
authors.lastname: Del Poeta
authors.forename: Sergio
authors.initials: S
authors.lastname: Amadori
authors.forename: Adriano
authors.initials: A
authors.lastname: Venditti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003581:Cytodiagnosis / Q000379:methods; D005260:Female; D005434:Flow Cytometry / Q000379:methods*; D006801:Humans; D017254:Leukemic Infiltration / Q000134:cerebrospinal fluid* / Q000175:diagnosis; D008297:Male; D008577:Meningeal Neoplasms / Q000134:cerebrospinal fluid / Q000209:etiology / Q000473:pathology*; D008578:Meninges / Q000473:pathology*; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000134:cerebrospinal fluid* / Q000150:complications; D012680:Sensitivity and Specificity; D055815:Young Adult