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Significance of CNS 2 cerebrospinal fluid status post‐induction in pediatric and adolescent patients with acute lymphoblastic leukemia
Author(s) -
Gurunathan Arun,
Desai Ami V.,
Bailey L. Charles,
Li Yimei,
Choi John K.,
Rheingold Susan R.
Publication year - 2019
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.27433
Subject(s) - medicine , cerebrospinal fluid , lymphoblastic leukemia , retrospective cohort study , cohort , acute leukemia , cohort study , induction therapy , central nervous system , oncology , leukemia , chemotherapy
Abstract Background At diagnosis, there are prognostic implications of low‐level leukemic blasts (CNS 2) in the cerebrospinal fluid (CSF) of patients with acute lymphoblastic leukemia (ALL). However, the significance of post‐induction CNS 2 results and the impact of equipment on CNS 2 prevalence have not been well studied. Procedure A single‐institution retrospective cohort study was conducted to analyze the outcome of patients with ≥1 post‐induction CNS 2. A subanalysis compared the proportion of CNS 2 CSF results using 2 different cytocentrifuges; the Shandon Cytospin used from 2005 to 2008 and the Wescor Cytopro used from 2010 to 2014. Results Over 4500 post‐induction CSF samples were analyzed, of which 59 were CNS 2. In covariate‐adjusted analyses, post‐induction CNS 2 did not significantly increase relapse risk. The proportion of CNS 2 results increased 4.3‐fold in noninfants and 6.3‐fold in infants using the Wescor Cytopro. Cytocentrifuge machine did not affect CNS 3 prevalence. Conclusions These findings support our current practice of not changing management based on a post‐induction CNS 2 CSF and highlight how equipment changes can significantly influence testing results. More data are needed to analyze relapse by subpopulations, such as those with repeated CNS 2 findings.