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Identification of risk groups for development of central nervous system
leukemia in adults with acute lymphocytic leukemia
HM Kantarjian, RS Walters, TL Smith, MJ Keating, B Barlogie, KB McCredie and EJ Freireich
Department of Hematology, University of Texas Cancer Center, M.D. Anderson
Hospital and Tumor Institute, Houston 77030.
The risk of development of CNS leukemia was investigated in 153 adults with
acute lymphocytic leukemia (ALL) who received systemic combination
chemotherapy without CNS prophylaxis. Overall, 31 patients (20%) developed
CNS leukemia after a median of 6 months of therapy; the estimated 1-year
incidence of CNS leukemia was 21% (SE, 3.9%). Characteristics significantly
associated with CNS involvement included the presence of elevated
hemoglobin creatinine, alkaline phosphatase, fibrinogen, and lactic
dehydrogenase levels; B-cell leukemia; and high leukemic cell proliferative
activity. Multivariate analysis identified lactic dehydrogenase levels of
greater than or equal to 600 U/L and greater than or equal to 14% of cells
in the S + G2M compartment to have independent additive poor prognostic
significance. Patients were categorized into different risk groups for CNS
leukemia with 1-year incidences ranging from 4% to 55%. While related to a
high occurrence of CNS leukemia at diagnosis (33%) and subsequently (100%),
the low incidence of B-cell disease excluded it from the multivariate
analysis. The use of systemic chemotherapy containing multiple agents with
good CNS penetration and in high doses (VAD regimen) in 90 patients was
associated with a trend for lower CNS leukemia at 1 year (15% v 31%),
especially in the low-risk category. We propose to develop future therapies
for adults with ALL that include risk-oriented CNS prophylactic approaches.
Volume 72,
Issue 5,
pp. 1784-1789,
11/01/1988
Copyright © 1988 by The American Society of Hematology
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