Factors That Influence the Appearance of Central Nervous System Leukemia

Abstract

At present, central nervous system (CNS) leukemia is one of the principal causes for termination of complete remission in acute lymphocytic leukemia (ALL). The factors which influence the increase of CNS infiltration have been studied comparing different parameters (age, initial peripheral WBC count, type of leukemia, and presence or absence of initial organomegaly) to determine the leukemia population with highest risk of developing this syndrome. A total of 127 cases of acute lymphoid leukemia (ALL) (98 children and 29 adults) and 101 acute myelocytic leukemia (AML) (41 children and 60 adults), on the same treatment protocol from 1967 to 1970, were included in this study. The median survival and the rate of incidence of symptomatic CNS leukemia was 18 mo and 32% in ALL and 4 mo and 7% in AML. The incidence of CNS leukemia per month of survival was similar in both groups: 4 mo, 3% in AML and 4% in ALL, at 8 mo, 13% in both ALL and AML. The incidence of CNS leukemia was higher in children with ALL than in adults: 41% in children and 19% in adults at 20-mo survival. Organomegaly (spleen, liver and/or lymph nodes) as an early manifestation increased the risk of CNS involvement. The CNS infiltration was significantly greater in patients with high initial peripheral WBC count. The incidence of meningeal leukemia did not differ in ALL and AML. In conclusion, CNS leukemia infiltration was more frequent in children with initial organomegaly and high WBC count at the time of diagnosis.

Acute nonlymphocytic leukemia in 171 children

“…Evans et al (52) reported the frequency of CNS leukemia to be 25% in ANLL and 56% in ALL. Their data and that of others (47) indicate that the frequency per unit time was similar in both types and that the frequency was directly related to the duration of survival. Nies et al (53) observed an increasing frequency of CNS leukemia during the 1953-1963 decade of 25-42% in ALL and 4-12% in ANLL.…”

“…While the actual frequencies span a broad range, there is general agreement that CNS leukemia is diagnosed more often in ALL than in ANLL (34,(47)(48)(49) and more often in children than in adults with either cell type (28,33,34,47,50). Among adults with ALL, however, the frequency of CNS leukemia may not differ with age (49).…”

“…Initial leukocyte counts tended to be higher, platelet counts lower, and hepatomegaly more frequent, though the differences were not statistically significant. In childhood ALL as well, an increased frequency of CNS leukemia has been reported in patients with low initial platelet counts (54), high initial leukocyte counts (47, 5 9 , and hepatosplenomegaly (47). It would appear, therefore, that the subsequent emergence of CNS leukemia to some degree is related to the initial opportunity for cells to implant in the meninges.…”

Central nervous system prophylaxis in haematological malignancies

“…Age is an important risk factor, with young children and infants more likely to experience CNS relapse. 6,9 Mature B-cell ALL and T-cell ALL are known to have an increased risk of CNS disease, both at presentation and relapse. Specific risk factors in children include: (i) high presenting leucocyte count (> 50 or > 100 × 10 9 /L, depending on the series), (ii) thrombocytopenia, (iii) lymphadenopathy and (iv) hepatosplenomegaly.…”

“…Specific risk factors in children include: (i) high presenting leucocyte count (> 50 or > 100 × 10 9 /L, depending on the series), (ii) thrombocytopenia, (iii) lymphadenopathy and (iv) hepatosplenomegaly. 9 In adults, high serum lactate dehydrogenase (LDH) and high proliferative index (i.e. cells in S (DNA synthesis) + G 2 (second cell growth) + M (mitosis) compartments of the cell cycle > 14%) are significant independent risk factors.…”