Craniospinal irradiation for acute lymphoblastic leukemia with central nervous system disease at diagnosis: A report from the children's cancer group

Cherlow, Joel M.; Sather, Harland N.; Steinherz, Peter G.; Gaynon, Paul S.; Tubergen, David G.; Trigg, Michael E.; Novak, Louis J.; Bleyer, W. Archie

doi:10.1016/s0360-3016(96)00272-6

Cited by 18 publications

(9 citation statements)

References 22 publications

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“…Whether cranial irradiation is necessary for patients with very high-risk ALL is uncertain. The Children's Cancer Group recently reported that craniospinal irradiation combined with intensive systemic and intrathecal therapy eliminates the poor prognostic impact generally ascribed to the presence of CNS leukemia at diagnosis [86]. Another recent study suggests that among children with T cell ALL whose initial leukocyte counts are greater than 100 x 10 9 /1, those treated with intensive triple intrathecal therapy alone have an inferior outcome compared to those who receive 12 Gy cranial irradiation [87].…”

Section: Treatmentmentioning

confidence: 99%

Childhood Acute Lymphoblastic Leukemia

Rubnitz

Pui

1997

The Oncologist

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The cure rate for childhood acute lymphoblastic leukemia (ALL) now exceeds 70%. This success has been achieved in part by improvements in the biologic characterization of newly diagnosed patients. Modern treatment protocols rely on this information to tailor therapy to a patient's risk of relapse. Patients with favorable genetic features, such as hyperdiploidy or the TEL‐AML1 fusion, can be treated with conventional antimetabolite‐based therapy to minimize long‐term side effects. By contrast, extremely high‐risk patients, such as infants with MLL gene rearrangements and cases with BCR‐ABL fusion and poor early response, are candidates for allogeneic hematopoietic stem cell transplantation in first remission. Future areas of research include the identification of new genetic subgroups of ALL and the development of novel therapies.

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Section: Treatmentmentioning

confidence: 99%

Childhood Acute Lymphoblastic Leukemia

Rubnitz

Pui

1997

The Oncologist

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“…Le LCR peut être le siège d'une atteinte tumorale au cours des hémopathies aiguës, au diagnostic initial ou lors de leur évolution. Au diagnostic de leucémie aiguë lymphoblastique (LAL), un envahissement méningé est identifié dans 3 à 5 % des cas chez l'enfant et 5 à 10 % des cas chez l'adulte, avec une plus grande fréquence au cours des LAL T et des formes hyperleucocytaires [1][2][3][4][5][6][7]. Dans les leucémies aiguës myéloblastiques (LAM), l'atteinte représente 10 % des cas chez l'enfant et moins de 5 % des cas chez l'adulte, et est plus fréquemment identifiée dans les LAM4 (FAB), LAM5 (FAB) et les formes hyperleucocytaires [5,[8][9][10][11][12][13][14][15].…”

Section: Synthèseunclassified

Recommendations for cerebrospinal fluid examination in acute leukemia

Girard¹,

Fenneteau²,

Mestrallet³

et al. 2017

Annales De Biologie Clinique

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L'identification cytologique de blastes dans le liquide céphalorachidien (LCR) au cours des hémopathies aiguës, lymphoïdes ou myéloïdes, de l'adulte et de l'enfant, au diagnostic initial ou lors de leur évolution conduit au diagnostic d'infiltration blastique méningée. La mise en place de thérapeutiques basées sur un risque « méningé », selon une classification standard internationale, a permis de réduire le nombre de rechutes cérébroméningées. Établie en 1993, cette classification permet, d'uniformiser les approches thérapeutiques en fonction du status de l'atteinte méningée. Basée sur la numération des hématies, des éléments nucléés, la présence de blastes, elle nécessite de disposer d'un mode opératoire uniforme pour obtenir des résultats d'analyse comparables entre laboratoires de biologie médicale. Afin d'améliorer la qualité d'analyse du LCR dans les leucémies aiguës, des recommandations préanalytiques (délai d'acheminement), analytiques (cytocentrifugation, addition de sérum enrichi en protéine, vitesse et durée de cytocentrifugation) et postanalytiques (durée de conservation) sont établies par le Groupe francophone d'hématologie cellulaire.Abstract. Cytological identification of blasts in cerebrospinal fluid in acute leukemia, lymphoid or myeloid, in adult and child, at diagnosis or during follow up lead to the diagnosis of leukemic meningitidis. Suitable CNS therapy based on a defined "CNS status" following an international standardized classification, lead to decrease cerebrospinal relapses. Established in 1993, this classification allows to treat patients based on their CNS status. Based on the red blood cells count, nucleated cells count and presence of blasts, it requires a standard technical procedure that guarantees the comparability of results coming from different medical laboratory. To improve the quality of cerebrospinal fluid analysis, in acute leukemias, preanalytical guidelines (turn around time), analytical guidelines (cytocentrifugation, adding serum protein, speed and duration of cytocentrifugation) and postanalytical guidelines (duration of conservation) are set by the Groupe francophone d'hématologie cellulaire.

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“…Other groups have not changed therapy based on CNS2 status [16,19]. A child with a traumatic lumbar puncture (with blasts) should be treated as CNS3, the COG uses an algorithm relating the WBC count and red blood cell counts in the spinal fluid and the peripheral blood film [23].…”

Section: Cns3 (Cns Disease)mentioning

confidence: 99%

Prognostic Significance of Cerebrospinal Fluid Lymphoblasts at Initial Presentation with Acute Lymphoblastic Leukemia Attending at Bangabandhu Sheikh Mujib Medical University, Bangladesh

Hafiz¹

2017

JPNC

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Background: Leukemia is characterized by persistent and enormous proliferation of immature white blood cell. Without CNS-directed therapy relapses originating from CNS are up to 75%. The presence of overt CNS disease at initial presentation (cranial nerve palsies) negatively affects the EFS of children with ALL. Early intensive intrathecal and systemic therapy is now more successful in treating and preventing CNS leukemia and reducing the cumulative risk for all relapses with CNS involvement of 4.4%, even in patients whose leukemic blast cells is iatrogenically introduced into the cerebrospinal fluid by traumatic lumbar puncture.

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Craniospinal irradiation for acute lymphoblastic leukemia with central nervous system disease at diagnosis: A report from the children's cancer group

Cited by 18 publications

References 22 publications

Childhood Acute Lymphoblastic Leukemia

Childhood Acute Lymphoblastic Leukemia

Recommendations for cerebrospinal fluid examination in acute leukemia

Prognostic Significance of Cerebrospinal Fluid Lymphoblasts at Initial Presentation with Acute Lymphoblastic Leukemia Attending at Bangabandhu Sheikh Mujib Medical University, Bangladesh

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