Immunophenotypic characteristics of cerebrospinal fluid cells in children
with acute lymphoblastic leukemia at diagnosis
AC Homans, BE Barker, EN Forman, CJ Cornell , JD Dickerman and JT Truman
Division of Pediatric Oncology, Brown University, Providence, RI.
The presence of meningeal involvement in children with acute lymphoblastic
leukemia (ALL) may have important prognostic and therapeutic implications.
Conventional methods of diagnosing central nervous system (CNS) leukemia
rely on the interpretation of cerebrospinal fluid (CSF) cell morphology,
which may produce ambiguous results in the presence of minimal leukemic
involvement. A methodology has been developed for immunophenotyping small
numbers of CSF cells while preserving cell morphology. CSF samples from 33
children with CD10 (common ALL antigen [CALLA]) positive ALL were examined
at initial presentation using both conventional morphology and this
combined immunohistopathologic technique. Six (18%) of the samples
contained lymphoblasts or cells considered morphologically suspicious for
leukemic involvement. Nine additional samples (27% of the total) had normal
CSF morphology, but contained increased numbers of CALLA positive cells.
Twelve of the 33 samples were also examined for the simultaneous presence
of nuclear terminal deoxynucleotidyl transferase (TdT) and demonstrated
increased numbers of cells positive for both TdT and CD10. These data
suggest that a large proportion of children with ALL may have abnormalities
of CSF cells at initial diagnosis consistent with the presence of occult
leukemic involvement.
Volume 76,
Issue 9,
pp. 1807-1811,
11/01/1990
Copyright © 1990 by The American Society of Hematology
