Significance of cerebrospinal fluid sIL-2R level as a marker of CNS involvement in acute lymphoblastic leukemia

Soluble IL-2 receptor (sIL-2R), total protein, uric acid, glucose, aspartate aminotransferase (AST) and lactate dehydrogenase (LD) levels were analyzed in 153 (19 cytology(+), 134 cytology(-)) pairs of CSF and serum samples and the data were compared with the results of cytologic examination to find new CSF markers of CNS involvement in 77 patients with acute lymphoblastic leukemia (ALL). The CSF leukocyte count of cytology(+) samples averaged 107.6+/-362.4 cells/microl, and was higher than that of cytology(-) samples (1.0+/-3.4 cells/microl, p=0.001). The CSF sIL2-R level of cytology(+) samples averaged 162.1+/-247.7 U/ml, and was higher than that of cytology(-) samples (11.2+/-44.6 U/ml, p <0.001). The CSF total protein, uric acid, glucose, AST, and LD levels were not significantly different in cytology(+) and cytology(-) samples (p >0.05). ROC curves showed that the discrimination power of CSF sIL2-R for the presence of leukemic blasts was better than that of CSF leukocyte counts. With a cut-off value for CSF sIL2-R at 10 U/ml, the sensitivity was 89.5% and the specificity was 89.6%. With a cut-off value for CSF leukocyte count at 4 cells/microl, the sensitivity and specificity were 47.4% and 63.2%, respectively. In conclusion, CSF sIL2-R level is a valuable marker of CNS involvement in ALL patients; a level of >10 U/ml may serve as an objective indicator of CNS involvement in conjunction with conventional cytology and the CSF leukocyte count.