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Impact of CSF Findings on Outcomes in B-Cell ALL
J Clin Oncol; ePub 2017 May 23; Winick, et al
Low levels of central nervous system (CNS) leukemia, regardless of red blood cells, predict worse outcome and higher rates of CNS relapse, according to a study involving nearly 8,400 children with B-cell acute lymphoblastic leukemia.
Investigators designated CSF status as follows: CNS1 (no blasts; n=7,395); CNS2a to 2c (<5 WBCs/μL and blasts with/without ≥10 RBCs/μL or ≥5 WBCs/μL plus blasts, with WBCs ≥5 times the number of RBCs; n=857); or CNS3a to 3c (≥5 WBCs/μL plus blasts with/without ≥ 10 RBCs/μL or clinical signs of CNS disease; n=127). Among the results:
- The 5-year event-free and overall survival rates in CNS1 patients were 85% and 93%, respectively.
- These rates in CNS2 were 76% and 88%, respectively; in CNS3 they were 76% and 82%, respectively.
- After adjusting for certain variables, CSF blast, regardless of cell count, independently predicted adverse outcome for patients with standard- or high-risk disease.
The authors concluded that expanding CNS-directed therapy is warranted for CNS2 disease.
Winick N, Devidas M, Chen S, et al. Impact of Initial CSF findings on outcome among patients with National Cancer Institute standard- and high-risk b-cell acute lymphoblastic leukemia: A report from the Children’s Oncology Group. [Published online ahead of print May 23, 2017]. J Clin Oncol. doi:10.1200/JCO.2016.71.4774.