Central nervous system relapse in adults with acute lymphoblastic leukemia

Surapaneni, Usha R.; Cortes, Jorge; Thomas, Deborah A.; O’Brien, Susan; Giles, Francis J.; Koller, Charles; Faderl, Stefan; Kantarjian, Hagop M.

doi:10.1002/cncr.10265

Cited by 85 publications

(89 citation statements)

References 30 publications

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“…9 We found no case of CNS recurrence after CSI, and perhaps the addition of spinal irradiation in the current study further improved the rate of second CNS recurrence. However, given the incomplete follow-up in these patients, this treatment strategy will need to be studied in a more controlled manner.…”

Section: Discussionsupporting

confidence: 53%

“…These results were inferior to those obtained in children but were similar to the reported outcomes in adults who developed a CNS recurrence of ALL. 9,11,12 However, the only two longterm survivors in the current study had received therapy modeled after this most effective therapy for children. This finding may represent the results of a better prognostic group because they were physically able to complete both systemic and intrathecal chemotherapy prior to CSI and did not have radiographic evidence of disease as some patients did.…”

Section: Discussionmentioning

confidence: 96%

“…As in children, a CNS recurrence in adults portends a poor prognosis; however, to our knowledge only a few studies published to date have reported outcomes in this group of patients. 8,9 Consequently, the current treatment of adults is based on the pediatric experience, with the majority of patients receiving CNS-targeted, dose-intense therapy. In the current study, we report what to our knowledge is the largest experience of CSI in adult patients with a CNS recurrence of leukemia.…”

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confidence: 99%

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The role of craniospinal irradiation in adults with a central nervous system recurrence of leukemia

Sanders

Cortes-Franco

et al. 2004

Cancer

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BACKGROUNDAlthough central nervous system (CNS) prophylaxis in patients with leukemia has reduced the incidence of CNS disease recurrence, it still is reported to occur in approximately 5–10% of cases, resulting in a median survival of 6 months. Craniospinal irradiation (CSI) has been shown to improve survival in children who develop a CNS recurrence of acute lymphocytic leukemia (ALL). However, to the authors' knowledge, the role of CSI in adults with a CNS recurrence of leukemia is unknown.METHODSA retrospective review of adult patients treated with CSI for a CNS recurrence of leukemia identified 16 patients treated between 1986 and 2001. The median age of the patients was 34 years (range, 16–58 years). The diagnoses included seven patients with acute myelogenous leukemia (AML), eight patients with ALL, and one patient with chronic myelogenous leukemia in blast crisis. All patients had achieved a complete disease remission prior to the CNS recurrence. Eleven patients had an isolated CNS recurrence and 5 patients had concurrent disease identified in the blood/bone marrow. The median dose of radiation was 24 grays (Gy) (range, 18–34.5 Gy) to the cranium and 18 Gy (range, 15–30 Gy) to the spine. The median fraction size was 1.8 Gy (range, 1.5–2.0 Gy) to the cranium and 1.5 Gy (range, 1.5–2.0 Gy) to the spine. Fifteen patients were also treated with intrathecal chemotherapy.RESULTSOne patient failed to complete radiation treatment because of disease progression. Thirteen patients achieved a complete response in the cerebrospinal fluid (CSF). The median time to disease progression was 3 months from the first day of CSI and 7 months from CNS recurrence. The median survival was 4 months and 9 months, respectively. No CNS recurrences occurred, but there were 11 bone marrow failures, 2 patients without recurrence at > 5 years, and 3 deaths without a documented site of failure. Thirteen patients had no evidence of disease in the CSF until their death or the time of last follow‐up.CONCLUSIONSCSI with or without intrathecal chemotherapy appears to be effective at eliminating leukemia in the craniospinal axis. However, the eradication of disease in the CNS was not found to be effective at preventing disease recurrence in the bone marrow, and despite improved control of disease in the CNS, adult patients with a CNS recurrence still had a poor prognosis. Furthermore, the rapidly fatal course of disease prevented an assessment of the durability of CNS response to irradiation. Cancer 2004. © 2004 American Cancer Society.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 96%

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confidence: 99%

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The role of craniospinal irradiation in adults with a central nervous system recurrence of leukemia

Sanders

Cortes-Franco

et al. 2004

Cancer

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“…Anderson Cancer Center between 1982 and 2000, 17 isolated CNS relapses were identified among 527 consecutive patients who did not receive cranial irradiation for prophylaxis. 40 The outcome for this group of patients was also dismal: 15 patients developed a subsequent hematologic relapse and 1 died in remission after 3 years; only 1 patient was alive and free of leukemia after 5 years. Since only 5 of these 17 patients received reinduction chemotherapy at the time of CNS relapse, 40 more intensive retrieval therapy might improve the future outlook for adults with isolated CNS relapse.…”

Section: Treatment Of Cns Relapsementioning

confidence: 90%

Central Nervous System Disease in Acute Lymphoblastic Leukemia: Prophylaxis and Treatment

Pui

2006

Hematology

105

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Improved treatment for acute lymphoblastic leukemia (ALL) has virtually eliminated testicular relapse. However, the control of central nervous system (CNS) leukemia remains a therapeutic challenge in childhood ALL, partly because of the late complications arising from cranial irradiation. In most current pediatric protocols, cranial irradiation (12 to 18 Gy) is given to 5% to 25% of patients—those with T-cell ALL, overt CNS disease (CNS3 status) or high-risk cytogenetics. CNS control is a less urgent concern in adults with ALL, in whom systemic relapse remains the major problem. With current approaches, approximately 2% to 10% of patients can be expected to develop CNS relapse. Children with B-cell precursor ALL who have a late CNS relapse (after an initial remission of 18 months or more) and did not receive cranial irradiation have an excellent outcome after retrieval therapy, with a 5-year event-free survival (EFS) rate approaching that in newly diagnosed patients. Innovative treatment options are needed for children who develop CNS relapses after a short initial remission or after receiving cranial irradiation, and in any adults with CNS leukemia at diagnosis or relapse.

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“…Several prognosis factors have been described [5,6] ALL rarely involve the central nervous system (CNS) at diagnosis [7], but the risk of relapse there without prophylaxis is particularly high [8,9]. Local neurologic recurrence alters prognosis [10,11] and constitutes a therapeutic challenge.…”

Section: Introductionmentioning

confidence: 99%

Craniospinal Irradiation (CSI) in Acute Lymphoblastic Leukemia: Comparison between Conformal Radiotherapy, Intensity-Modulated Radiotherapy, and Helical Tomotherapy (HT)

Jacob¹,

JP²,

Chira³

2012

J Nucl Med Radiat Ther

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Central nervous system relapse in adults with acute lymphoblastic leukemia

Cited by 85 publications

References 30 publications

The role of craniospinal irradiation in adults with a central nervous system recurrence of leukemia

The role of craniospinal irradiation in adults with a central nervous system recurrence of leukemia

Central Nervous System Disease in Acute Lymphoblastic Leukemia: Prophylaxis and Treatment

Craniospinal Irradiation (CSI) in Acute Lymphoblastic Leukemia: Comparison between Conformal Radiotherapy, Intensity-Modulated Radiotherapy, and Helical Tomotherapy (HT)

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