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

Levinsen, Mette; Marquart, Hanne V.; Groth-Pedersen, Line; Abrahamsson, Jonas; Albertsen, Birgitte K.; Andersen, Mette K.; Frandsen, Thomas L.; Harila-Saari, Arja; Pronk, Cornelis LU and Ulvmoen, Aina, et al. (2016) In Pediatric Blood & Cancer 63(11). p.1935-1942
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:... (More)

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 × 109/l vs. 10 × 109/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.

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published
subject
keywords
acute, ALL, CSF leukemia, leukemias, minimal residual disease
in
Pediatric Blood & Cancer
volume
63
issue
11
pages
8 pages
publisher
John Wiley and Sons Inc.
external identifiers
  • scopus:84988370301
  • wos:000387023500012
ISSN
1545-5009
DOI
10.1002/pbc.26128
language
English
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yes
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de3e0bc9-0026-48ae-aae6-08424b7734a7
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2017-01-17 08:10:43
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2017-10-01 05:28:58
@article{de3e0bc9-0026-48ae-aae6-08424b7734a7,
  abstract     = {<p>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 &lt; 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<sup>9</sup>/l vs. 10 × 10<sup>9</sup>/l, P &lt; 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.</p>},
  author       = {Levinsen, Mette and Marquart, Hanne V. and Groth-Pedersen, Line and Abrahamsson, Jonas and Albertsen, Birgitte K. and Andersen, Mette K. and Frandsen, Thomas L. and Harila-Saari, Arja and Pronk, Cornelis and Ulvmoen, Aina and Vaitkevičienė, Goda and Lähteenmäki, Päivi M. and Niinimäki, Riitta and Taskinen, Mervi and Jeppesen, Maria and Schmiegelow, Kjeld},
  issn         = {1545-5009},
  keyword      = {acute,ALL,CSF leukemia,leukemias,minimal residual disease},
  language     = {eng},
  month        = {11},
  number       = {11},
  pages        = {1935--1942},
  publisher    = {John Wiley and Sons Inc.},
  series       = {Pediatric Blood & Cancer},
  title        = {Leukemic blasts are present at low levels in spinal fluid in one-third of childhood acute lymphoblastic leukemia cases},
  url          = {http://dx.doi.org/10.1002/pbc.26128},
  volume       = {63},
  year         = {2016},
}