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Blood, 15 November 2000, Vol. 96, No. 10, pp. 3381-3384
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Traumatic lumbar puncture at diagnosis adversely affects outcome
in childhood acute lymphoblastic leukemia
Amar Gajjar,
Patricia L. Harrison,
John T. Sandlund,
Gaston K. Rivera,
Raul C. Ribeiro,
Jeffrey E. Rubnitz,
Bassem Razzouk,
Mary V. Relling,
William E. Evans,
James M. Boyett, and
Ching-Hon Pui
From the Departments of Hematology-Oncology,
Biostatistics and Epidemiology, Pharmaceutical Sciences, and Pathology,
St Jude Children's Research Hospital, Memphis, TN; and the Colleges of
Medicine and Pharmacy, University of Tennessee, Memphis, TN.
The effect of traumatic lumbar puncture at the time of
initial diagnostic workup on treatment outcome in children with newly diagnosed acute lymphoblastic leukemia (ALL) was investigated. The
findings of the first 2 lumbar punctures performed on 546 patients with
newly diagnosed ALL treated on 2 consecutive front-line studies
(1984-1991) at St Jude Children's Research Hospital were retrospectively reviewed. Lumbar punctures were performed at the time
of diagnosis and again for the instillation of first intrathecal chemotherapy. The event-free survival (EFS) experience for patients with 1 cerebrospinal fluid (CSF) sample contaminated with blast cells
was worse than that for patients with no contaminated CSF samples
(P = .026); that of patients with 2 consecutive
contaminated CSF samples was particularly poor (5-year
EFS = 46 ± 9%). In a Cox multiple regression analysis, the
strongest prognostic indicator was 2 consecutive contaminated CSF
samples, with a hazard ratio of 2.39 (95% confidence interval,
1.36-4.20). These data indicate that contamination of CSF with
circulating leukemic blast cells during diagnostic lumbar puncture can
adversely affect the treatment outcome of children with ALL and is an
indication to intensify intrathecal therapy.
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