title: Clinical outcome and efficacy of current anti-leukemic therapy for leptomeningeal involvement in acute myeloid leukemia.
abstract: We investigated risk factors and outcome in acute myeloid leukemia (AML) patients with leptomeningeal involvement. Medical records of patients with non-promyelocytic AML at Seoul National University Hospital from January of 2000 to November of 2013 were reviewed. Leptomeningeal involvement was defined as the presence of atypical or malignant hematopoietic cells in the cerebrospinal fluid. Among 775 patients with AML, 141 patients (18.2 %) underwent cerebrospinal fluid examination. Leptomeningeal involvement of AML, confirmed in 38 patients (4.9 %), was associated with high white blood cell count and high level of lactic. There were seven patients in the favorable risk group (19.4 %), 21 in the intermediate risk group (58.3 %), and eight in the adverse risk group (22.2 %). Twenty-eight patients (85.7 %) developed leptomeningeal involvement during relapse status or refractory status. Thirty-one patients (81.6 %) received intrathecal chemotherapy, and whole-brain and/or craniospinal radiotherapy was conducted in 10 patients (27.0 %). The rate of complete remission after induction chemotherapy was 63.2 %. Median overall survival was 9.9 months. Radiotherapy and complete remission after the first induction chemotherapy were associated with longer overall survival. Leptomeningeal involvement in acute myeloid leukemia is rare, but relatively common in relapsed status or refractory status. Craniospinal radiotherapy and complete remission after induction chemotherapy were found to favorable prognostic factors.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul National University, College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, Republic of Korea.|Department of Internal Medicine, ChungBuk National University Hospital, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju, Chungchungbuk-do, Republic of Korea.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Kwon
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul National University, College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, Republic of Korea.|Cancer Research Institute, College of Medicine, Seoul National University, 101 Daehak-ro, Chongno-gu, Seoul, Republic of Korea.
authors.forename: Young-Il
authors.initials: YI
authors.lastname: Koh
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul National University, College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, Republic of Korea.|Cancer Research Institute, College of Medicine, Seoul National University, 101 Daehak-ro, Chongno-gu, Seoul, Republic of Korea.
authors.forename: Sung-Soo
authors.initials: SS
authors.lastname: Yoon
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul National University, College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, Republic of Korea.|Cancer Research Institute, College of Medicine, Seoul National University, 101 Daehak-ro, Chongno-gu, Seoul, Republic of Korea.
authors.forename: Seonyang
authors.initials: S
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul National University, College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, Republic of Korea. ihkimmd@snu.ac.kr.|Cancer Research Institute, College of Medicine, Seoul National University, 101 Daehak-ro, Chongno-gu, Seoul, Republic of Korea. ihkimmd@snu.ac.kr.
authors.forename: Inho
authors.initials: I
authors.lastname: Kim
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D002555:Cerebrospinal Fluid / Q000166:cytology; D006801:Humans; D007278:Injections, Spinal; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017254:Leukemic Infiltration / Q000175:diagnosis* / Q000188:drug therapy / Q000532:radiotherapy; D008578:Meninges / Q000473:pathology*; D011878:Radiotherapy / Q000379:methods; D012008:Recurrence; D012074:Remission Induction / Q000379:methods; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Acute myeloid leukemia; Craniospinal radiotherapy; Intrathecal chemotherapy; Leptomeningeal involvement; Risk factor