High peripheral blast count in adult acute myelogenous leukemia is a primary risk factor for CNS leukemia.

Abstract

The lengthening remission duration achievable in acute myelogenous leukemia (AML) places patients at risks for CNS leukemic relapse. We reviewed the data on two Eastern Cooperative Oncology Group (ECOG) trials in acute nonlymphocytic leukemia to determine the incidence of CNS leukemia (CNSL). The incidence of CNSL was 5% (30 of 569 patients) overall, and 3% (ten of 331) in patients in complete remission (CR). A number of factors were evaluated for association with increased risk of CNSL. Men more frequently developed CNSL than women at a three to one ratio, and median presenting WBC counts were higher in affected than unaffected patients (44,200/microL v 17,000/microL, P = .01). The low incidence of CNSL in AML supports the view that CNS prophylaxis is unnecessary. However, because 68% of patients (13 of 19) who developed CNSL early in the course of disease had presenting WBC counts greater than 40,000/microL, screening lumbar punctures should be routinely obtained during induction therapy in patients presenting with high circulating blast cell counts.

Central nervous system involvement at first relapse in patients with acute myeloid leukemia

“…We hypothesize that modern chemotherapies including frequent stem cell transplantation might reduce the risk of central nervous system relapse by eliminating the residual leukemic cells in the central nervous system or in the bone marrow, or both. On the other hand, we were not able to confirm the previously reported associations between central nervous system relapse and FAB M4/M5 subtypes, 3,5,10,21 the cytogenetic abnormality inv(16), 7 male sex, 4 and high white blood cell count at diagnosis. 3,4,7 Elevated serum lysozyme concentration, a marker of monocytic acute myeloid leukemia, 11 and increased lactate dehydrogenase serum concentration, as described by Stewart et al, 6 were both significantly associated with central nervous system relapse.…”

“…In fact, the cumulative incidence of relapse was 3.9% in groups 1 and 2 (old protocols) which is consistent with the previously published series, 4-9 compared with 0.3% in groups 3 and 4 (modern protocols). Unlike other studies, 4,[6][7][8][9][10] patients with biological entities requiring characteristic treatment, such as those with acute promyelocytic leukemia, 2 were excluded from the present analysis. Our study included a series of unselected, consecutively diagnosed, adult acute myeloid leukemia patients and, therefore, shows an unbiased incidence of central nervous system relapse.…”

“…3 The present study showed an overall 5-year cumulative incidence of central nervous system relapse of 1.3% (either isolated or combined with bone marrow relapse), which is lower than the previously reported incidence of 3-11%. [4][5][6][7][8][9][10] The different statistical methods used to calculate the incidence in our study (competing risk analysis using the CI) compared with others (crude incidence) may explain, at least in part, our different rate of central nervous system relapse. Another explanation is that most previous studies were performed exclusively in patients treated with old chemotherapy protocols in the 1980s, 4-9 whereas in our series most of the patients were treated with modern protocols.…”

“…1 To our knowledge, this complication has been critically assessed in patients with acute promyelocytic leukemia (APL) 2 and children with acute myeloid leukemia. 3 However, the prevalence of and risk factors for central system involvement in adult patients with acute myeloid leukemia have been analyzed in only a few studies carried out in the 1980s [4][5][6][7][8] and 1990s. 9,10 No studies to date have analyzed the incidence of and risk factors for central nervous system relapse using the most appropriate statistical methods, i.e.…”

Fatal Cerebral Leucostasis in Acute Leukaemia with Hyperleucocytosis

“…Focal central nervous system deficits may herald intracranial haemorrhage. Fatal intracerebral haemorrhage may occur [6]. Priapism, enlarged kidneys, hyperuricaemia and renal failure are features of genitourinary involvement.…”