PURPOSE: To determine the significance of blasts in the CSF without pleiocytosis and a traumatic lumbar puncture in children with acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS: We retrospectively studied a cohort of 526 patients treated in accordance with the virtually identical Dutch protocols ALL-7 and ALL-8. Patients were classified into five groups: CNS1, no blasts in the CSF cytospin; CNS2, blasts present in the cytospin, but leukocytes less than 5/microL; CNS3, blasts present and leukocytes more than 5/microL. Patients with a traumatic lumbar puncture (TLP; > 10 erythrocytes/mL) were classified as TLP+ (blasts present in the cytospin) or TLP- (no blasts). RESULTS: Median duration of follow-up was 13.2 years (range, 6.9 to 15.5 years). Event-free survival (EFS) was 72.6% (SE, 2.5%) for CNS1 patients (n = 304), 70.3% (SE, 4.7%) for CNS2 patients (n = 111), and 66.7% (SE, 19%) for CNS3 patients (n = 10; no significant difference in EFS between the groups). EFS was 58% (SE, 7.6%) for TLP+ patients (n = 62) and 82% (SE, 5.2%) for TLP- patients (n = 39; P < .01). Cox regression analysis identified TLP+ status as an independent prognostic factor (risk ratio, 3.5; 95% CI, 1.4 to 8.8; P = .007). Cumulative incidence of CNS relapses was 0.05 and 0.07 in CNS1 and CNS2 patients, respectively (not statistically significant). CONCLUSION: In our experience, the presence of a low number of blasts in the CSF without pleiocytosis has no prognostic significance. In contrast, a traumatic lumbar puncture with blasts in the CSF specimen is associated with an inferior outcome.
PURPOSE: To determine the significance of blasts in the CSF without pleiocytosis and a traumatic lumbar puncture in children with acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS: We retrospectively studied a cohort of 526 patients treated in accordance with the virtually identical Dutch protocols ALL-7 and ALL-8. Patients were classified into five groups: CNS1, no blasts in the CSF cytospin; CNS2, blasts present in the cytospin, but leukocytes less than 5/microL; CNS3, blasts present and leukocytes more than 5/microL. Patients with a traumatic lumbar puncture (TLP; > 10 erythrocytes/mL) were classified as TLP+ (blasts present in the cytospin) or TLP- (no blasts). RESULTS: Median duration of follow-up was 13.2 years (range, 6.9 to 15.5 years). Event-free survival (EFS) was 72.6% (SE, 2.5%) for CNS1 patients (n = 304), 70.3% (SE, 4.7%) for CNS2 patients (n = 111), and 66.7% (SE, 19%) for CNS3 patients (n = 10; no significant difference in EFS between the groups). EFS was 58% (SE, 7.6%) for TLP+ patients (n = 62) and 82% (SE, 5.2%) for TLP- patients (n = 39; P < .01). Cox regression analysis identified TLP+ status as an independent prognostic factor (risk ratio, 3.5; 95% CI, 1.4 to 8.8; P = .007). Cumulative incidence of CNS relapses was 0.05 and 0.07 in CNS1 and CNS2 patients, respectively (not statistically significant). CONCLUSION: In our experience, the presence of a low number of blasts in the CSF without pleiocytosis has no prognostic significance. In contrast, a traumatic lumbar puncture with blasts in the CSF specimen is associated with an inferior outcome.
Authors: Yousif Matloub; Bruce C Bostrom; Stephen P Hunger; Linda C Stork; Anne Angiolillo; Harland Sather; Mei La; Julie M Gastier-Foster; Nyla A Heerema; Scott Sailer; Patrick J Buckley; Blythe Thomson; Catherine Cole; James B Nachman; Gregory Reaman; Naomi Winick; William L Carroll; Meenakshi Devidas; Paul S Gaynon Journal: Blood Date: 2011-05-11 Impact factor: 22.113
Authors: Naomi Winick; Meenakshi Devidas; Si Chen; Kelly Maloney; Eric Larsen; Leonard Mattano; Michael J Borowitz; Andrew Carroll; Julie M Gastier-Foster; Nyla A Heerema; Cheryl Willman; Brent Wood; Mignon L Loh; Elizabeth Raetz; Stephen P Hunger; William L Carroll Journal: J Clin Oncol Date: 2017-05-23 Impact factor: 44.544
Authors: Ching-Hon Pui; Dario Campana; Deqing Pei; W Paul Bowman; John T Sandlund; Sue C Kaste; Raul C Ribeiro; Jeffrey E Rubnitz; Susana C Raimondi; Mihaela Onciu; Elaine Coustan-Smith; Larry E Kun; Sima Jeha; Cheng Cheng; Scott C Howard; Vickey Simmons; Amy Bayles; Monika L Metzger; James M Boyett; Wing Leung; Rupert Handgretinger; James R Downing; William E Evans; Mary V Relling Journal: N Engl J Med Date: 2009-06-25 Impact factor: 91.245