Changes of CSF-Cu and -Zn in children with acute lymphoblastic leukemia

In 20 Dutch children with acute lymphoblastic leukemia (ALL), Cu and Zn levels in cerebrospinal fluid (CSF) were studied during standard treatment (Protocol ALL-BFM-86/SNWLK-ALL-VII). CSF-Cu in 10 controls was 0.04 +/- 0.02 mumol/L, lower compared to values in adults. At the moment of diagnosis, CSF-Cu values were higher, 0.06 +/- 0.03 mumol/L, and during maintenance therapy lower, 0.01 +/- 0.01 mumol/L. Children with central nervous system (CNS) involvement ALL as judged by CAT Scan and EEG--in addition to cytology--showed lower CSF-Cu values compared to children without. CSF-Zn values were also measured. CSF-Zn was 0.05 mumol/L and did not vary. Cu/Zn molar ratios were increased at the onset of treatment, and decreased during maintenance therapy. The changes in CSF-Cu may follow the natural course of the disease or may relate to the success of treatment, reflecting a decrease of leukemia activity. Another explanation concerns a risk of CNS damage by low CSF-Cu causing neuron dysfunction. Conditions necessary for the interpretation of these results into a clinical strategy for followup study are outlined.