[Association of cerebrospinal fluid status with prognosis in children with acute lymphoblastic leukemia]
Wen-Yu Yang1, Ye Guo, Xiao-Juan Chen
1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China. xfzhu@ihcams.ac.cn.
Insights
Central nervous system infiltration-positive (CNSI+) acute lymphoblastic leukemia (ALL) in children impacts recurrence-free survival differently across chemotherapy stages. CNSI+ patients in the consolidation/maintenance stage show higher recurrence rates.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Immunology
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- Central nervous system (CNS) involvement in ALL requires careful monitoring and treatment.
- Flow cytometry is a key diagnostic tool for identifying CNS infiltration.
Purpose of the Study:
- To investigate the clinical characteristics of children with CNSI+ ALL.
- To determine the association between clinical features of CNSI+ ALL and patient prognosis.
- To compare outcomes in different chemotherapy stages.
Main Methods:
- Retrospective analysis of clinical data from 66 CNSI+ ALL children (April 2008 - June 2013).
- Comparison of clinical features, laboratory results, and prognosis between induction and consolidation/maintenance chemotherapy stages.
- Flow cytometry used for CNSI+ diagnosis.
Main Results:
- CNSI+ children in the consolidation/maintenance stage had higher rates of good prognosis genes and recurrence compared to the induction stage.
- Recurrent CNSI+ ALL patients in the consolidation/maintenance stage showed higher rates of CNS and bone marrow relapse, and positive cerebrospinal fluid.
- Recurrence-free survival was significantly higher in the induction stage, while overall survival showed no significant difference between stages.
Conclusions:
- CNSI+ status significantly affects recurrence-free survival in pediatric ALL across different chemotherapy phases.
- CNSI+ ALL patients in the consolidation/maintenance stage exhibit an increased risk of recurrence.
- Overall survival is not significantly impacted by CNSI+ status in different chemotherapy stages.
Objective:
To study the clinical features of central nervous system infiltration-positive (CNSI+) children with acute lymphoblastic leukemia (ALL) based on flow cytometry, as well as the association of such clinical features with prognosis.
Methods:
A retrospective analysis was performed for the clinical data of 66 CNSI+ children with ALL treated from April 2008 to June 2013. Clinical features, laboratory examination results and prognosis were compared between the children in different chemotherapy stages (induction stage and consolidation/maintenance stage).
Results:
Among the 66 CNSI+ children, 50 were in the induction stage and 16 in the consolidation/maintenance stage. Compared with the CNSI+ children in the induction stage, the CNSI+ children in the consolidation/maintenance stage had a significantly higher proportion of children with the genes associated with good prognosis based on the results of molecular biology (P<0.05), as well as a significantly higher recurrence rate (P<0.05). Recurrence was observed in 21 CNSI+ ALL children, among whom 10 were in the induction stage and 11 were in the consolidation/maintenance stage. Compared with the children experiencing recurrence in the induction stage, the children experiencing recurrence in the consolidation/maintenance stage had a significantly higher proportion of children with recurrence of the central nervous system and bone marrow (P<0.05), as well as significantly higher proportion of biochemical positive rate of cerebrospinal fluid (P<0.05). The children in the induction stage had a significantly higher recurrence-free survival rate than those in the consolidation/maintenance stage (P<0.001), while there was no significant difference in overall survival rate between the two groups (P>0.05).
Conclusions:
In children with ALL, CNSI+ has a marked effect on recurrence-free survival rate in different chemotherapy stages, but has no obvious effect on overall survival rate. CNSI+ patients in the consolidation/maintenance stage have a higher recurrence.
