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Prognostic factors for clinical outcomes of patients with central nervous system leukemia
Jinai Bharucha1, Qing Cao2, Zohar Sachs3
1University of Minnesota Medical School, Minneapolis, MN, USA.
Insights
Central nervous system (CNS) leukemia in acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) patients has poor survival. Pediatric age and avoiding cranial radiation improve outcomes for CNS leukemia patients.
Area of Science:
- Hematology
- Oncology
- Neuro-oncology
Background:
- Central nervous system (CNS) involvement in acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) presents unique challenges.
- Prognostic factors for CNS leukemia outcomes remain incompletely understood, impacting treatment strategies.
Purpose of the Study:
- To identify prognostic factors associated with clinical outcomes in pediatric and adult patients with CNS leukemia.
- To evaluate factors influencing CNS leukemia remission and overall survival.
Main Methods:
- Retrospective analysis of 66 patients (41 ALL, 25 AML) with CNS leukemia.
- Evaluation of patient characteristics, treatment, remission rates, and survival at 36 months.
Main Results:
- Complete remission of CNS leukemia was achieved in 88% of patients.
- Overall survival at 36 months was 43%.
- Factors for remission included systemic leukemia remission and pre-transplant treatment. Pediatric age, pre-transplant diagnosis, leukemia clearance, avoidance of cranial radiation, and intrathecal chemotherapy consolidation improved survival.
Conclusions:
- CNS leukemia patients face significant mortality risk.
- Modifiable factors like avoiding cranial radiation and using intrathecal chemotherapy consolidation can improve outcomes for select patients.
Abstract:
Prognostic factors associated with clinical outcomes of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) patients with central nervous system (CNS) involvement are unknown. We retrospectively studied the characteristics and outcomes of 66 (18 pediatric and 48 adult) patients with CNS leukemia with ALL (n = 41) or AML (n = 25). The median age of patients at diagnosis of CNS leukemia was 30 (range, 1-69) years. Nearly two-third patients had CNS involvement at the initial diagnosis of leukemia. Complete remission of CNS leukemia was attained in 58 (88%) patients, and probability of overall survival at 36 months after the diagnosis of CNS leukemia was 43% for the entire cohort. We identified that achieving remission of systemic leukemia and having CNS leukemia diagnosed and treated before allogeneic transplantation were the factors associated with CNS leukemia remission. Prognostic factors associated with better overall survival in patients with CNS leukemia included pediatric age, diagnosis of CNS leukemia before receiving allogenic transplantation, achieving clearance of systemic or CNS leukemia, receiving no cranial radiation in conjunction with intrathecal chemotherapy (IT), and receiving IT consolidation after achieving remission of CNS leukemia. Our findings show that patients with CNS leukemia are at considerable risk of mortality. Awareness of modifiable prognostic factors such as avoidance of cranial radiation whenever possible and use of IT consolidation can result in improved outcomes in subset of patients with CNS leukemia.
