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The utility of performing the initial lumbar puncture on day 8 in remission induction therapy for childhood acute lymphoblastic leukemia: TCCSG L99‐15 study
Author(s) -
Hasegawa Daisuke,
Manabe Atsushi,
Ohara Akira,
Kikuchi Akira,
Koh Katsuyoshi,
Kiyokawa Nobutaka,
Fukushima Takashi,
Ishida Yasushi,
Saito Tomohiro,
Hanada Ryoji,
Tsuchida Masahiro
Publication year - 2012
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.22965
Subject(s) - medicine , lumbar puncture , incidence (geometry) , cumulative incidence , prednisolone , cerebrospinal fluid , prospective cohort study , lumbar , cyclophosphamide , leukemia , cohort , pediatrics , chemotherapy , surgery , physics , optics
Background Traumatic lumbar puncture with leukemic blasts (TLP+), which has been reported to occur 5–10%, in the previous studies, adversely affects the outcome of children with acute lymphoblastic leukemia (ALL). Based on the results from our previous study, we deferred the initial lumbar puncture until day 8 in remission induction therapy in order to reduce the frequency of cases with TLP+. Procedure The study was conducted as a prospective cohort study within the Tokyo Children's Cancer Study Group (TCCSG) L99‐15 study. Between April 1999 and June 2003, 754 children with newly diagnosed ALL enrolled. The patients received the initial intrathecal chemotherapy after 7 days of prednisolone treatment. The incidence of central nervous system (CNS)‐positive (the presence of leukemic blasts in cerebrospinal fluid or cranial nerve palsy) including TLP+ cases and cumulative incidence of CNS relapse were examined. Results The incidence of CNS‐positive and TLP+ was 2.9% (n = 22) and 0.8% (n = 6), respectively. These incidences were much lower than those in the representative study groups employing the initial IT on day 1. Of 22 patients with CNS‐positive, only one patient relapsed in CNS, whereas 22 of the remaining CNS‐negative 723 patients suffered from CNS relapse. Overall, event‐free survival at 4 year was 78.2 ± 1.6%. Four‐year cumulative incidence of any CNS relapse was 3.3 ± 0.7%, which improved from our previous study in spite of limiting the use of cranial irradiation. Conclusions Our strategy reduced the frequency of CNS‐positive patients who required reinforcement of CNS‐directed therapy without compromising overall outcome. Pediatr Blood Cancer 2012; 58: 23–30. © 2011 Wiley Periodicals, Inc.