Risk factors and clinical outcomes of acute myeloid leukaemia with central nervous system involvement in adults

Abstract

BackgroundAcute myeloid leukaemia (AML) with central nervous system (CNS) involvement in adults is uncommon, and studies of this subject are scant.MethodsWe conducted a retrospective study to investigate the clinical aspects, cytogenetic abnormalities, molecular gene mutations and outcomes of adult AML patients with CNS involvement. Three hundred and ninety-five patients with newly diagnosed AML were reviewed.ResultsTwenty (5.1%) patients had CNS involvement, including 7 (1.8%) with initial CNS disease and 4 (1%) who suffered an isolated CNS relapse. The patients with CNS involvement were younger, had higher leukocyte, platelet, and peripheral blast cell counts, FAB M4 morphology, and chromosome translocations involving 11q23 (11q23 abnormalities) more frequently than did the patients without CNS involvement. No differences in sex, haemoglobin levels, serum LDH levels, immunophenotype of leukaemia cells, or molecular gene mutations were observed between the two groups. Multivariate analyses showed that age ≤ 45 years (OR, 5.933; 95% CI, 1.82 to 19.343), leukocyte counts ≥ 50,000/μl (OR, 3.136; 95% CI, 1.083 to 9.078), and the presence of 11q23 abnormalities (OR, 5.548; 95% CI, 1.208 to 25.489) were significant predictors of CNS involvement. Patients with initial CNS disease had 5-year overall survival and relapse-free survival rates that were similar to those without initial CNS disease. However, three of four patients who suffered an isolated CNS relapse died, and their prognosis was as poor as that of patients who suffered a bone marrow relapse.ConclusionCNS involvement in adult patients with AML is rare. Three significant risk factors for CNS involvement including age ≤ 45 years, leukocyte counts ≥ 50,000/μl and the presence of 11q23 abnormalities were identified in this study. Future investigations to determine whether adult AML patients having these specific risk factors would benefit from CNS prophylactic therapy are necessary.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1376-9) contains supplementary material, which is available to authorized users.

Central nervous system disease in pediatric acute myeloid leukemia: A report from the Children's Oncology Group

“…In adult AML protocols, a diagnostic LP is not performed in order to prevent contamination of the CSF with blasts unless there are signs of CNS disease present. [2][3][4] Our data suggest that traumatic taps in patients who are treated similar to our protocols do not confer a higher risk of treatment failure.…”

How I treat acute myeloid leukemia presenting with preexisting comorbidities

“…101,102 In older patients, in whom the risk of rebleeding is significantly high and allogeneic transplantation is not a practical option, we consider less myeloablative therapy, such as hydroxyurea, low-dose cytarabine, or hypomethylating agents. 100,103 This patient has a high risk for CNS involvement based on the myelomonocytic lineage morphology and leukocytosis [104][105][106] but there is no firm evidence to suggest a connection between ICH and CNS involvement of leukemia. 107 Although ICH preceded the diagnosis of leukemia by 6 weeks and the patient has poorly controlled hypertension For personal use only.…”

Primary and Secondary Central Nervous System Involvement in Acute Myeloid Leukemia

“…AML rarely invades areas other than the bone marrow, but in such instances, the most commonly afflicted organs are soft tissues, lymphatic tissues, and skin [6][7][8][9]. Central Nervous System involvement (CNSi) is rare [10][11][12][13].…”