CNS Involvement in Paediatric AML Patients: Real-world Data from a Tertiary Care Center

Acute myeloid leukaemia (AML) is an aggressive malignancy, with central nervous system (CNS) involvement carrying significant prognostic implications. This study assessed the clinical relevance of CNS involvement at diagnosis in Indian perspective of paediatric AML cases, focusing on the t(8::21) translocation. We retrospectively analysed 45 paediatric AML patients diagnosed between 2022 and 2024. Data on CNS status, cytogenetics particularly t(8::21), molecular markers (AML-ETO with or without c-kit, FLT3-ITD/TKD, NPM1 etc.), WBC count, and LDH levels were collected and correlated with clinical outcomes. CNS2 or CNS3 involvement was observed in 25% of cases., more frequently in younger children (p = 0.04). There were 33% patient having t(8::21). CNS3 patients had a significantly higher relapse rate (80%) compared to CNS1 (25%). AML-ETO and FLT3-ITD were linked to poorer prognosis. Elevated WBC and LDH levels, particularly in FAB M4 and M5 subtypes, were associated with aggressive disease. CNS involvement in paediatric AML is linked to poor outcomes, especially in younger age group with t(8::21) have more incidence of CNS manifestations. Routine CNS assessment and early CNS-directed therapy, such as intrathecal chemotherapy or clinical trial are critical. Further research on the molecular drivers of CNS infiltration is needed to improve risk stratification and therapy.