Central nervous system (CNS) involvement has an adverse impact on survival in newly diagnosed adult acute lymphoblastic leukemia (ALL) assessed by flow cytometry

Córdova-Serrano, Rosana Daniela; Almanza-Huante, Emmanuel; Fernández-Sánchez, Emmanuel; A, Hernandez-Alcantara; Espinosa-Bautista, Karla

doi:10.1080/10428194.2021.1957872

Cited by 4 publications

(2 citation statements)

References 42 publications

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“…9,10,[20][21][22] We cannot exclude that some patients with CNS-2 disease could have been under reported in our study while their poor outcome in children is debated. 9,10,20 CSF flow cytometry, which can increase the likelihood of identifying patients from 6 -13% to 18-25%, [23][24][25][26] was not routinely available at a multicentric level at the time of the GRAALL-2005 study since it requires either special conditioning or rapid processing. 23,24 CNS involvement has been associated with an increased risk of relapse in some [23][24][25]27 but not all studies.…”

Section: Discussionmentioning

confidence: 99%

“…9,10,20 CSF flow cytometry, which can increase the likelihood of identifying patients from 6 -13% to 18-25%, [23][24][25][26] was not routinely available at a multicentric level at the time of the GRAALL-2005 study since it requires either special conditioning or rapid processing. 23,24 CNS involvement has been associated with an increased risk of relapse in some [23][24][25]27 but not all studies. 26 In the latter report, additional intrathecal therapy (twice weekly until the CSF and symptoms had cleared, then once weekly for 4 weeks) did not mitigate the worse outcome despite the rapid clearance of blast cells in the CSF.…”

Section: Discussionmentioning

confidence: 99%

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Impact of central nervous system involvement in adult patients with Philadelphia-negative acute lymphoblastic leukemia: a GRAALL-2005 study

et al. 2023

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Whereas the prognosis of adult patients with Philadelphia-negative acute lymphoblastic leukemia (ALL) has greatly improved since the advent of pediatric-inspired regimens, the impact of initial central nervous system (CNS) involvement has not been formerly reevaluated. We report herein the outcome of patients with initial CNS involvement included in the pediatric-inspired prospective randomized GRAALL-2005 study. Between 2006 and 2014, 784 adult patients (18-59 years old) with newly diagnosed Philadelphia-negative ALL were included of whom 55 (7%) had CNS involvement. In CNS-positive patients, overall survival was shorter (median 1.9 years vs. not reached, HR=1.8 [1.3-2.6], P

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of central nervous system involvement in adult patients with Philadelphia-negative acute lymphoblastic leukemia: a GRAALL-2005 study

et al. 2023

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Flow cytometry for meningeal infiltration in B acute lymphoblastic leukemia in a low middle income country

Anane,

Lakhal,

Salem

et al. 2024

Cytometry Part B Clinical

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Meningeal infiltration in children with B acute lymphoblastic leukemia is one of the most serious complications. Timely diagnosis not only significantly enhances treatment efficacy but also leads to improve patient outcome and reduce risk of relapse. This is particularly crucial in low to middle income countries facing health constraints, where optimizing resources is essential. Conventional cytology (CC) study of cerebrospinal fluid (CSF) is considered in different countries to be the Gold‐standard despite its low sensitivity (< 50%). The study of CSF by multiparametric flow cytometry (MFC) appears to be an alternative. The aim of our study was to assess MFC analytical performance compared with CC. Our cross sectional study was conducted over a six‐month period in the biological hematology department. CSF samples underwent analysis for the presence of blasts using both CC and MFC. Cytological slides of the CSF were prepared by cytocentrifugation in a Shandon Cytospin 4™. Flow cytometric analysis was performed on the BD FACSLyric™ flow cytometer. All statistical analyses were performed using SPSS version 21.0 (SPSS Inc.). Agreement between the two methods was made using the Kappa index and χ2 test. This study was approved by the local ethics committee. Sixty CSF samples from 39 children with B acute lymphoblastic leukemia were analyzed. Meningeal infiltration was detected respectively in 20% of cases by MFC and 5% of cases by CC, with a significant difference p = 0.006. Comparing the two methods, the Kappa coefficient was 0.35, indicating weak agreement between the two methods. Moreover, MFC positivity was higher even for hypocellular samples. Of the 51 hypocellular samples, eight were positive by MFC while they were negative by CC. MFC shows better sensitivity while retaining good specificity for the detection of meningeal involvement. MFC could therefore be a complementary method to CC for detecting blast cells in the central nervous system.

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How I prevent and treat central nervous system disease in adults with acute lymphoblastic leukemia

Kopmar

Cassaday

2023

Blood

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The central nervous system (CNS) is the most important site of extramedullary disease in adults with acute lymphoblastic leukemia (ALL). While CNS disease is identified only in a minority of patients at the time of diagnosis, subsequent CNS relapses (either isolated or concurrent with other sites) will occur in some patients, even after delivery of prophylactic therapy targeted to the CNS. Historically, prophylaxis against CNS disease has included intrathecal (IT) chemotherapy and radiotherapy (RT), although the latter is being used with decreasing frequency. Treatment of a CNS relapse usually involves intensive systemic therapy and cranial or craniospinal RT along with IT therapy, and consideration of allogeneic hematopoietic cell transplant (HCT). However, short- and long-term toxicities can make these interventions prohibitively risky, particularly for older adults. As new antibody-based immunotherapy agents have been approved for relapsed/refractory B-cell ALL, their use specifically in patients with CNS disease is an area of keen interest, both because of the potential for efficacy but also concerns of unique toxicity to the CNS. In this review, we discuss data-driven approaches for these common and challenging clinical scenarios, as well as highlight how recent findings potentially support the use of novel immunotherapeutic strategies for CNS disease.

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Central nervous system (CNS) involvement has an adverse impact on survival in newly diagnosed adult acute lymphoblastic leukemia (ALL) assessed by flow cytometry

Abstract: Central nervous system (CNS) involvement has an adverse impact on survival in newly diagnosed adult acute lymphoblastic leukemia (ALL) assessed by flow cytometry, Leukemia & Lymphoma,

Cited by 4 publications

References 42 publications

Impact of central nervous system involvement in adult patients with Philadelphia-negative acute lymphoblastic leukemia: a GRAALL-2005 study

Impact of central nervous system involvement in adult patients with Philadelphia-negative acute lymphoblastic leukemia: a GRAALL-2005 study

Flow cytometry for meningeal infiltration in B acute lymphoblastic leukemia in a low middle income country

How I prevent and treat central nervous system disease in adults with acute lymphoblastic leukemia

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