Central nervous system involvement in acute nonlymphocytic leukemia. A prospective study of adults in remission

Bruce A Peterson, Richard D. Brunning, Clara D. Bloomfield, David D. Hurd, Jane A. Gau, Grace T. Peng, Anne I. Goldman

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28 Scopus citations

Abstract

To identify adults with acute nonlymphocytic leukemia at risk for the development of central nervous system involvement, we performed periodic cerebrospinal fluid examinations on patients in remission. Among 58 consecutive patients monitored during first remission, central nervous system leukemia developed in nine (16 percent). Four patients, including one who was symptomatic, had central nervous system leukemia detected simultaneously with marrow relapse. Five additional patients were asymptomatic and continue to have bone marrow remission. Following central nervous system and systemic treatment, two of these five patients have never had relapse, and three had relapse in the bone marrow five, 10, and 21 months later. Factors at diagnosis associated with the subsequent development of central nervous system leukemia were elevated leukocyte count, serum lysozyme and lactate dehydrogenase, extramedullary infiltration including splenomegaly, and monocytic (FAB M4 or M5a) morphology. In six of 17 patients (35 percent) with monocytic morphology, central nervous system leukemia developed compared with only three of 41 patients (7 percent) with other subtypes (p = 0.02). Discriminant analysis identified leukocyte count, splenomegaly, and M4 or M5a morphology as the most important risk factors and led to a mathematical formula that correctly identified 90 percent of the patients. Although the risk of central nervous system leukemia in adults with acute nonlymphocytic leukemia is too low to justify routine prophylaxis, those patients recognized to be at greater risk should receive prophylaxis or be monitored closely with periodic lumbar punctures.

Original languageEnglish (US)
Pages (from-to)464-470
Number of pages7
JournalThe American Journal of Medicine
Volume83
Issue number3
DOIs
StatePublished - Sep 1987

Bibliographical note

Funding Information:
From the Division of Oncology, Department of Medicine, the Department of Laboratory Medicine and Pathology, and the School of Public Health, Division of Biometry, University of Minnesota Health Sciences Center, Minneapolis, Minnesota. This work was supported in part by the Coleman Leukemia Research Fund and the Masonic Memorial Hospital Fund, Inc. Requests for reprints should be addressed to Dr. Bruce A. Peterson, Box 348 UMHC, Division of Oncology, Department of Medicine, University of Minnesota Hospital and Clinic, Minneapolis, Minnesota 55455. Manuscript submitted December 1986, and accepted March 11, 1987.

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