Flow cytometric analysis of cerebrospinal fluid improves detection of leukaemic blasts in infants with acute lymphoblastic leukaemia

Abstract

Infants with acute lymphoblastic leukaemia (ALL) have a high frequency of central nervous system (CNS) involvement. Flow cytometric analysis of cerebrospinal fluid (CSF) was recently demonstrated to be a sensitive method for detecting CNS involvement in childhood ALL. In the present study, CSF from 14 infants was collected at routine lumbar punctures and analysed by multicolour flow cytometry. At initial diagnosis, leukaemic blasts were detected in CSF by flow cytometry in 11 patients (78Á6%) compared to seven patients (50%) by cytospin. Larger studies are needed to determine if CSF flow cytometry has prognostic value in infant ALL.

Technological features of blast identification in the cerebrospinal fluid: A systematic review of flow cytometry and laboratory haematology methods

“…As an example of this increase in sensitivity, Cancela et al noted an increase in CSF involvement from 4% to 17% for specimens tested by flow cytometry in addition to morphologic analysis in their study of 72 specimens from paediatric B‐ALL patients 8 . The increased sensitivity of flow cytometry versus cytomorphology for detection of blasts has been reported by others 23,34–42 and appears to have clinical significance. For adult B‐ALL patients without morphologic evidence of disease but having a blast population identified by flow cytometry, the abnormal flow cytometry result was associated with an adverse outcome 9,20,43 .…”

Incidence and prognostic value of central nervous system involvement in infants with B‐cell precursor acute lymphoblastic leukemia treated according to the MLL‐Baby protocol

“…As expected, the incidence of CNS‐2 and CNS‐3 disease status was higher in the KMT2A ‐r group than in the KMT2A ‐g group. Theoretically, leukemic blast detection in CSF could be improved by MFC application, 33,34 although in the age category assessed in this study, this technology is rarely applied 35 . The presence of CNS leukemia is rarely used for stratification purposes in infants with BCP‐ALL 1 .…”

“…Theoretically, leukemic blast detection in CSF could be improved by MFC application, 33,34 although in the age category assessed in this study, this technology is rarely applied. 35 The presence of CNS leukemia is rarely used for stratification purposes in infants with BCP-ALL. 1 On the other hand, one of the keys to the relative success of the Japanese MLL-10 trial was the inclusion of CNS leukemia as a criterion for high-risk group inclusion as well as the wide HSCT application in this group.…”

Does minimal central nervous system involvement in childhood acute lymphoblastic leukemia increase the risk for central nervous system toxicity?

“…Flow cytometric immunophenotyping (FCI) is more sensitive than CM and can detect low levels of blasts in CSF despite normal CM findings but is not routinely used in clinical diagnostics. [2][3][4][5][6] Current treatment protocols include CNS-directed chemotherapy for all patients to reduce relapse risk, even in the absence of signs or symptoms of CNS leukemia, while those with known CNS involvement receive enhanced intrathecal chemotherapy. 1,3 Recent studies suggest that CNS leukemia defined by CM increases the risk for CNS toxicities and early posterior reversible encephalopathy syndrome (PRES).…”

“…Traditionally, the diagnosis of leukemic cells in the cerebrospinal fluid (CSF) is performed by cytomorphology (CM). Flow cytometric immunophenotyping (FCI) is more sensitive than CM and can detect low levels of blasts in CSF despite normal CM findings but is not routinely used in clinical diagnostics 2–6 …”