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Pediatr Blood Cancer. 2016 Nov;63(11):1935-42. doi: 10.1002/pbc.26128. Epub 2016 Jul 22.

Leukemic blasts are present at low levels in spinal fluid in one-third of childhood acute lymphoblastic leukemia cases.

Author information

1
Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.
2
Department of Clinical Immunology, University Hospital Rigshospitalet, Copenhagen, Denmark.
3
Department of Pediatrics, Institution of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden.
4
Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.
5
Department of Clinical Genetics, University Hospital Rigshospitalet, Copenhagen, Denmark.
6
Department of Pediatrics, Astrid Lindgrens Hospital, Stockholm, Sweden.
7
Department of Pediatrics, Skåne University Hospital, Lund, Sweden.
8
Department of Pediatrics, Oslo University Hospital, Norway.
9
Centre for Pediatric Oncology and Hematology, University Children's Hospital, Vilnius, Lithuania.
10
Department of Pediatrics, Turku University Hospital, Turku, Finland.
11
Department of Pediatrics, Oulu University Hospital, Oulu, Finland.
12
Children and Adolescents, Helsinki University Hospital, Helsinki, Finland.
13
Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark. kschmiegelow@rh.dk.
14
Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark. kschmiegelow@rh.dk.
15
Division of Pediatric Hematology/Oncology, Perlmutter Cancer Center, NYU Langone Medical Center, New York. kschmiegelow@rh.dk.

Abstract

BACKGROUND:

Central nervous system (CNS) involvement is associated with relapse in childhood acute lymphoblastic leukemia (ALL) and is a diagnostic challenge.

PROCEDURE:

In a Nordic/Baltic prospective study, we assessed centralized flow cytometry (FCM) of locally fixed cerebrospinal fluid (CSF) samples versus local conventional cytospin-based cytology (CC) for detecting leukemic cells and evaluating kinetics of elimination of leukemic cells in CSF.

RESULTS:

Among 300 patients with newly diagnosed ALL, 87 (29%) had CSF involvement by FCM, while CC was positive in 30 (10%) of 299 patients with available CC data (P < 0.001). Patients with FCM+/CC+ had higher CSF leukemic blast counts compared to patients positive by FCM only (medians: 0.10 vs. 0.017 leukemic blasts/μl, P = 0.006). Patients positive by FCM had higher white blood cell counts in peripheral blood than patients negative by FCM (medians: 45 × 10(9) /l vs. 10 × 10(9) /l, P < 0.001), were younger (medians: 3 years vs. 4 years, P = 0.03), and more frequently had T-cell ALL (18/87 vs. 16/213, P = 0.001). At treatment day 15, five of 52 patients (10%) who had CSF positive by FCM at diagnosis remained so despite at least two doses of weekly intrathecal chemotherapy.

CONCLUSIONS:

Longer follow-up is needed to clarify whether FCM positivity has prognostic significance and is an indicator for intensified CNS-directed therapy.

KEYWORDS:

ALL; CSF leukemia; acute; leukemias; minimal residual disease

PMID:
27447373
DOI:
10.1002/pbc.26128
[Indexed for MEDLINE]

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