Blood, 1973, Vol. 42, No. 6, pp. 935-938.
© 1973 American Society of Hematology, Inc.
Factors That Influence the Appearance of
Central Nervous System Leukemia
Santiago Pavlovsky 1,
Mariana Eppinger-Helft 2, and
Federico Sackmann Muriel 3
1 Academia Nacionale de
Medicina, Buenos Aires
2 Hospital de Niños, Buenos Aires
3 Instituto Municipal de Hematología, Hospital Ramos Mejía, Buenos Aires
At present, central nervous system (CNS)
leukemia is one of the principal causes for
termination of complete remission in acute
lymphocytic leukemia (ALL). The factors
which influence the increase of CNS infiltration have been studied comparing
different parameters (age, initial peripheral WBC count, type of leukemia, and
presence or absence of initial organomegaly) to determine the leukemia population
with highest risk of developing this syndrome. A total of 127 cases of acute
lymphoid leukemia (ALL) (98 children and
29 adults) and 101 acute myelocytic leukemia (AML) (41 children and 60 adults),
on the same treatment protocol from 1967
to 1970, were included in this study. The
median survival and the rate of incidence
of symptomatic CNS leukemia was 18 mo
and 32% in ALL and 4 mo and 7% in AML.
The incidence of CNS leukemia per month
of survival was similar in both groups:
4 mo, 3% in AML and 4% in ALL, at 8 mo,
13% in both ALL and AML. The incidence
of CNS leukemia was higher in children
with ALL than in adults: 41% in children
and 19% in adults at 20-mo survival.
Organomegaly (spleen, liver and/or
lymph nodes) as an early manifestation
increased the risk of CNS involvement. The
CNS infiltration was significantly greater
in patients with high initial peripheral
WBC count. The incidence of meningeal
leukemia did not differ in ALL and AML. In
conclusion, CNS leukemia infiltration was
more frequent in children with initial
organomegaly and high WBC count at the
time of diagnosis.
Submitted on November 8, 1972
Revised on January 29, 1973
Accepted on February 28, 1973
