Detection of occult cerebrospinal fluid involvement during maintenance therapy identifies a group of children with acute lymphoblastic leukemia at high risk for relapse |
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Authors: | Carolina Martínez‐Laperche Ana M. Gómez‐García Álvaro Lassaletta Cristina Moscardó José L. Vivanco Javier Molina José L. Fuster José M. Couselo José Sánchez de Toledo Encarnación Bureo Luis Madero Manuel Ramírez |
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Affiliation: | 1. Servicio de Oncohematología, Hospital Universitario Ni?o Jesús, , Madrid, Spain;2. Oncohematología Pediátrica, Hospital General Universitario de Alicante, , Alicante, Spain;3. Unidad de Oncohematología Infantil, Hospital Universitario Doce de Octubre, , Madrid, Spain;4. Unidad de Pediatría, Hospital Virgen del Camino, , Pamplona, Spain;5. Oncologia Pediátrica, Hospital Universitario Virgen de la Arrixaca, , Murcia, Spain;6. Hospital Clínico Universitario de Santiago de Compostela, , Spain;7. Unidad de Oncología y Hematología Pediátrica Hospital Valle de Hebrón, , Barcelona, Spain;8. Servicio de Hematologia, Hospital Universitario Marques de Valdecilla, , Santander, Spain |
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Abstract: | We aimed at assessing the clinical significance of the levels of acute lymphoblastic leukemia (ALL) cells in samples of cerebrospinal fluid (CSF) during therapy. We studied 990 CSF samples from 108 patients, at the time of diagnosis (108) and at each time of intrathecal therapy (882). The proportions of leukemic cells in CSF samples were assessed by flow cytometry (FCM). Patients with central nervous system (CNS) involvement at diagnosis (FCM+) showed predominantly a T‐ALL, and higher percentages of known negative prognostic factors: high risk group, higher white blood cell counts, normal karyotype, and the BCR‐ABL fusion gene. No differences in relapse free survival (RFS) and overall survival (OS) were observed between FCM+ versus FCM? at diagnosis. Patients with CNS involvement during therapy showed significantly older age, and higher frequencies of T‐cell leukemia. We found a significantly higher RFS in patients with FCM+ during therapy. The detection of subclinical CNS disease by FCM during maintenance was associated with significantly lower 3‐years RFS and 3‐years OS. A sensitive methodology like FCM can be applied for a close follow‐up of the levels of ALL in CFS samples, and may identify a group of patients at high risk for relapse. Am. J. Hematol. 88:359–364, 2013. © 2013 Wiley Periodicals, Inc. |
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