title: [Clinical Characteristics and Prognosis of 21 Cases of Acute Lymphoblastic Leukemia with Central Nervous System Leukemia].
abstract: OBJECTIVE
  To investigate the clinical characteristics, therapeutic efficacy survival and prognosis of patients with adult acute lymphoblastic leukemia (ALL) accompanied by central nervous system leukemia (CNSL).
  
  
  METHODS
  The clinical and cerebrospinal fluid (CSF) features, diagnosis and treatment, therapeutic efficacy and survival rate of 21 cases of acute lymphoblastic leukemia (ALL) with central nervous system involvement (CNSL) were analyzed retrospectively.
  
  
  RESULTS
  Out of 21 cases, 10 cases were B cell acute lymphoblastic leukemia(B-ALL), 6 cases were T cells acute lymphoblastic(T-ALL), 4 cases were determined as no clear typing, 1 case was Burkitt lymphoma/leukemia, 7 patients had CNSL at the time of diagnosis, and 14 patients were showed CNS relapse. Clinical manifestations included headache, facial paralysis, limb weakness and blurred vision, etc. Their median follow-up time was 19(6-40) months,from them 10 cases died, 7 cases survived, 4 cases were lost to follow up. Patients had CNSL at the time of diagnosis, their peripheral blood LDH≥600 U/L or not achieving complete remission (CR) after 1 course of treatment with poor prognosis, and the difference is significant (P< 0.05). Radiotherapy and allogeneic stem cell transplantation (allo-HSCT) could improve the patient's survival. Multivariate analysis showed that the LDH and allo-HSCT was significantly correlated with survival time (P=0.048, P=0.013).
  
  
  CONCLUSIONS
  There are no specific clinical manifestations, CSF features and imaging manifestations of ALL accompanied by CNSL, and the diagnosis of CSF is needed to find the leukemia cells in CSF. The factors for poor prognosis include LDH≥600 U/L, no CR of patients after 1 course of treatment, existence of CNSL at the diagnosis. ALL patients with CNSL have a poor prognosis. Intrathecal injection combined with systemic chemotherapy, radiation therapy and allo-HSCT after CR is the feasible and effective treatment regimen.
authors.affiliation: Department of Hematology,Chinese PLA General Hospital,Beqing 100853, China.
authors.forename: Xiang-Shu
authors.initials: XS
authors.lastname: Jin
authors.affiliation: Department of Hematology,Chinese PLA General Hospital,Beqing 100853, China.
authors.forename: Lan
authors.initials: L
authors.lastname: Yang
authors.affiliation: Department of Hematology,Chinese PLA General Hospital,Beqing 100853, China.
authors.forename: Bian-Hong
authors.initials: BH
authors.lastname: Wang
authors.affiliation: Department of Hematology,Chinese PLA General Hospital,Beqing 100853, China.
authors.forename: Hong-Hua
authors.initials: HH
authors.lastname: Li
authors.affiliation: Department of Hematology,Chinese PLA General Hospital,Beqing 100853, China.
authors.forename: Li
authors.initials: L
authors.lastname: Yu
authors.affiliation: Department of Hematology,Chinese PLA General Hospital,Beqing 100853, China. E-mail: jingyu301@126.com.
authors.forename: Yu
authors.initials: Y
authors.lastname: Jing
mesh_terms: D000328:Adult; D016543:Central Nervous System Neoplasms; D018380:Hematopoietic Stem Cell Transplantation; D006412:Hematopoietic Stem Cells; D006801:Humans; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous; D016896:Treatment Outcome