Central nervous system involvement in patients with acute myeloid leukemia

Abstract

Background/aim To evaluate the incidence, clinical features, risk factors, and prognosis of central nervous system (CNS) involvement in patients with acute myeloid leukemia (AML). Materials and methods All AML patients who were admitted to Hacettepe University hospital between 2000 and 2021 were evaluated. The medical records of 548 AML cases were retrospectively analyzed. Results The frequency of CNS involvement was 2.4% (n = 13) at diagnosis and 4.6% (n = 25) at diagnosis or during follow-up. Parenchymal involvement was seen in 5 patients, leptomeningeal involvement was seen in 11 patients. Three patients had both leptomeningeal and parenchymal involvements, and 6 patients had optic nerve or ocular involvement. In univariate analysis, younger age and extramedullary involvement at diagnosis were associated with CNS disease at diagnosis, and extramedullary involvement at diagnosis was associated with CNS disease during follow-up. In multivariate analysis; younger age and extramedullary involvement at diagnosis were associated with CNS disease at diagnosis and during follow-up respectively. Median overall survival was 5.4 months in patients with CNS disease at diagnosis and 16.9 months in patients with CNS disease during follow-up and 16.2 months in patients with no CNS disease. Conclusion CNS disease is a rare complication of AML. Younger age and extramedullary involvement at diagnosis are risk factors for CNS involvement.

Incidence, risk factors, and outcome of asymptomatic central nervous system involvement in adult patients with acute myeloid leukemia

“…In our study, we confirmed the association of CNS pos status with lymphadenopathy, a higher percentage of BM blasts, WBC ≥30 � 10 9 /L, and presence of the monocytic phenotype in asymptomatic patients, which is in line with previous reports. [1][2][3][4][5][13][14][15]17 Besides, our patient group also had a higher…”

“…Our patients were selected according to the risk factors proposed by data reported in the literature. [1][2][3][4][5][13][14][15][16][17][18][19] Most patients in our selected series were asymptomatic. The overall incidence of CNS involvement in the whole group was 12.6%, which is higher that reported in other publications.…”

“…literature, the prevalence of CNS involvement differs extensively (0.6%-32%), mostly due to the fact that baseline screening of asymptomatic CNS involvement is not recommended as standard procedure for adults with de novo AML. [1][2][3][4][5][6][7] Additionally, diverse methods of its detection have been used. Namely, contemporary application of multiparametric flow cytometry (MFC) for cerebrospinal fluid (CSF) analysis, a more sensitive diagnostic tool compared with conventional cytomorphology (CC), has further emphasized these discrepancies.…”

“…12 There are reports indicating that CNS involvement is more prone in younger AML patients with higher pre-treatment levels of serum lactate dehydrogenase (LDH), higher white blood cell (WBC) count, the monocytic phenotype, expression of CD56, other sites of EMD at diagnosis, FLT3-internal tandem duplication (FLT3-ITD) mutations, specific cytogenetic abnormalities in inversion 16, 11q23, t(8:21), and trisomy 8. [1][2][3][4][5][13][14][15][16][17][18][19] So far, the effect of CNS involvement at diagnosis on clinical outcome in adults with AML is still unclear. Some studies have revealed that AML patients with CNS involvement have worse outcomes than those without CNS involvement.…”

“…[1][2][3]14,17 In contrast, results of other investigations, including a recent retrospective analysis of 3240 patients with newly diagnosed AML from 11 consecutive clinical trials, 15 showed no difference in overall survival (OS) between AML patients with and without CNS disease at presentation. 4,5 Furthermore, several publications have reported that pre-transplant CNS involvement did not have an independent effect on the hematopoietic stem cell transplantation (HSCT) outcome. [20][21][22][23] This study aimed to determine the incidence of asymptomatic CNS involvement estimated by MFC of CSF (MFC-CSF) at diagnosis, the related potential risk factors.…”