Diagnostic Cerebrospinal Fluid Examination in Children With Acute Lymphoblastic Leukemia: Significance of Low Leukocyte Counts With Blasts or Traumatic Lumbar Puncture

Abstract

CNS2 patients have the same prognosis as patients with CNS1 status, whereas the EFS of TLP+ patients is inferior to CNS1 but superior to CNS3 patients (P =.001). Both subgroups may have benefitted from additional IT MTX.

The utility of performing the initial lumbar puncture on day 8 in remission induction therapy for childhood acute lymphoblastic leukemia: TCCSG L99‐15 study

“…Since the outcome of patients with TLPþ was shown to be unfavorable [2,[9][10][11], many efforts to minimize TLPþ have been made, including correction of thrombocytopenia, use of deep sedation, orgeneral anesthesia, and cautious procedure by the most skilled clinicians [7,19]. Although the design of the present study was not a randomized fashion, ourresults indicate thatthefrequencyofpatients with TLPþ was reduced considerably (below 1%) by performing the initial LP after 7-day monotherapy of PSL, which was consistent with our previous L89-12 study [12].…”

“…Ã Poor cytogenetics (BCR-ABL and MLL rearrangement) versus others: P < 0.01, E2A-PBX1 versus others: P ¼ 0.06, favorable cytogenetics (high hyperdiploid and TEL-AML1) versus others: P ¼ 0.03. Table III shows comparisons of the proportion of initial CNS status, EFS rate, and CNS relapse rate between the TCCSG studies [12] adopting day 8 IT strategy and the representative study groups employing the initial IT on day 1; the BFM group [10] and the St. Jude Children's Research Hospital (SJCRH) [2,17]. The initial LP/IT done on day 8 in remission induction therapy resulted in the decrease in the proportion of CNS-2, CNS-3, and TLPþ; however, the frequency of CNS-1s and TLPÀ was almost the same between BFM-95 and TCCSG studies.…”

“…The prognostic significance of the presence of leukemic blasts in the cerebrospinal fluid (CSF) without pleocytosis, referred to as CNS-2, has varied in clinical trials and is heavily dependent on the effectiveness of systemic and CNS-directed therapy [8][9][10][11]. By contrast, traumatic lumbar puncture with leukemic blasts (TLPþ) adversely affects the outcome of patients with ALL as well as overt CNS leukemia [2,[9][10][11]. Though controversy over whether TLPþ is an iatrogenic event or intrinsically inevitable status still exists, clinicians should pay attention to keep the rate of TLPþ to a minimum.…”

Long-term results of Dutch Childhood Oncology Group studies for children with acute lymphoblastic leukemia from 1984 to 2004

“…In both the ALL-7 and ALL-8 study patients, the adverse effect of a traumatic lumbar puncture with the presence of blasts at diagnosis is suggested and those patients may benefit from additional CNS-directed chemotherapy. 25,26,27 The DCOG Total Therapy-based treatment strategies ALL-6 and ALL-9 study made clear that many children with ALL can be cured without using anthracyclines, cyclofosphamide and epipodophyllotoxins, such as etoposide. This may especially hold true for the majority of patients with TEL/AML1 rearranged ALL.…”

Long-term results of five consecutive trials in childhood acute lymphoblastic leukemia performed by the ALL-BFM study group from 1981 to 2000

“…In the more recent ALL-BFM 95 study, the exact CNS status was determined by exact count of blasts and WBC, but also by analyzing whether a traumatic lumbar puncture may have taken place. 25 Immunophenotyping was performed as previously described. 26 Cytogenetic studies were performed using standard techniques.…”