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The risks of central nervous system relapse and leukoencephalopathy in
patients receiving marrow transplants for acute leukemia
CB Thompson, JE Sanders, N Flournoy, CD Buckner and ED Thomas
The records of 415 patients who received allogeneic marrow transplants for
acute leukemia were reviewed to assess the risk of central nervous system
(CNS) relapse and leukoencephalopathy after marrow transplantation. The
Kaplan-Meier estimates of the probability of CNS relapse posttransplant
were 13% for patients with acute lymphoblastic leukemia (ALL) and 2% for
patients with acute nonlymphoblastic leukemia (ANL). Previous CNS disease
was significantly correlated with an increased risk of CNS relapse in
patients transplanted for ALL but not for ANL. In contrast, bone marrow
involvement with leukemia at the time of transplant was associated with an
increased risk of CNS relapse in patients with ANL but not in patients with
ALL. Seventy-one patients with ALL did not receive posttransplant
intrathecal methotrexate (IT- MTX) and 127 did. The probability of CNS
relapse in these two groups was 38% and 7%, respectively (P less than .02).
This protective benefit from IT-MTX was present in patients both with and
without a history of CNS involvement or marrow involvement at the time of
transplant. In patients with ANL, 116 patients did not receive
posttransplant IT-MTX and 101 patients did, but no protection from CNS
relapse was observed from IT-MTX irrespective of a patient's previous CNS
history or marrow status at the time of transplant. Leukoencephalopathy was
seen exclusively in patients who had received radiation and/or intrathecal
chemotherapy to the CNS before preparation for marrow transplantation and
posttransplant IT-MTX. In such patients the risk of leukoencephalopathy was
7%. From our data, it appears that posttransplant IT-MTX is a significant
benefit for ALL patients in preventing CNS relapse after marrow
transplantation. A similar benefit from posttransplant IT-MTX for ANL
patients cannot be established from this study. In both groups, increasing
total CNS therapy was associated with an increasing risk of
leukoencephalopathy.
Volume 67,
Issue 1,
pp. 195-199,
01/01/1986
Copyright © 1986 by The American Society of Hematology
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