Prognosis of Initial CNS Involvement in Acute Lymphoblastic Leukemia Childhood

Abstract

The introduction of an effective prophylaxis of the CNS involvement represented great progress in the treatment of acute lympho-blastic leukemia (ALL), since until some years ago CNS involvement was considered to be incurable once it became manifest. In the Berlin-Frankfurt-Miinster BFM-ALL studies isolated CNS relapses occur relatively seldomly, but manifestation of a CNS-leukemia by the time of diagnosis is still considered a risk factor for subsequent relapses [1]. We analyzed the prognosis of the initial CNS involvement in 41 children from four multicenter ALL therapy studies of our Arbeitsgemeinschaft fur Padiatrische Hamatologie und Onkologie of the GDR. In the GDR-ALL-VII (81) study, which is a slightly modified ALL-BFM 81-protocol, we also investigated the patients’ characteristics with an initial CNS involvement in compar-ison with the total group of patients of this study in order to discover associations with other risk factors. Finally, we tried to find out whether the signs of the initial CNS manifestation are important for the progno-sis. The question for the prognostic risk of a “smoldering” meningeal leukemia was of special interest, i.e., the findings of leukemic blasts in the CSF without elevation of the CSF cell count.