Abstract
Incidence and effect on outcome of central nervous system (CNS) involvement in adult patients with acute myeloid leukemia (AML) is not clearly defined. To address this issue, 103 consecutive adult patients with newly diagnosed AML, regardless of neurologic symptoms, were submitted to a routine explorative lumbar puncture. Cerebrospinal fluid (CSF) samples were collected from 65 males and 38 females. All 103 CSF samples were examined by conventional cytology (CC) whereas 95 (92%) also by flow cytometry (FCM). At diagnosis, 70 patients (68%) were CNS negative (CNS−), whereas 33 (32%) were CNS positive (CNS+). In 11 of 33 (33%), CNS infiltration was documented either by CC or FCM, in 21 (67%) only by FCM. CNS positivity was significantly associated with a M4-M5 phenotype of the underlying AML (P =.0003) and with high levels of lactate dehydrogenase (P =.006). Overall, 80 of 103 (78%) achieved complete remission with no significant differences between CNS+ and CNS− patients. Five-year disease-free survival and overall survival were found to be shorter in CNS+ patients than in those CNS− (18% vs 50%, P =.006 and 19% vs 46%, P =.02, respectively). In multivariate analysis, CNS status and age were found to affect independently overall survival. In conclusion, the incidence of CNS involvement in adult patients with newly diagnosed AML is higher than expected. Regardless of neurologic symptoms, it should always be searched at diagnosis; CSF samples should routinely be investigated by FCM since a certain proportion of CNS involvements might remain undetected if examination is exclusively CC based.
| Original language | English |
|---|---|
| Journal | Seminars in Hematology |
| DOIs | |
| Publication status | Accepted/In press - Jan 1 2018 |
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Keywords
- Acute myeloid leukemia
- Central nervous system disease
- Conventional cytology
- Flow cytometry
- Outcome
ASJC Scopus subject areas
- Hematology
Cite this
Involvement of central nervous system in adult patients with acute myeloid leukemia : Incidence and impact on outcome. / Del Principe, Maria Ilaria; Buccisano, Francesco; Soddu, Stefano; Maurillo, Luca; Cefalo, Mariagiovanna; Piciocchi, Alfonso; Consalvo, Maria Irno; Paterno, Giovangiacinto; Sarlo, Chiara; De Bellis, Eleonora; Zizzari, Annagiulia; De Angelis, Gottardo; Fraboni, Daniela; Divona, Mariadomenica; Voso, Maria Teresa; Sconocchia, Giuseppe; Del Poeta, Giovanni; Lo-Coco, Francesco; Arcese, William; Amadori, Sergio; Venditti, Adriano.
In: Seminars in Hematology, 01.01.2018.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Involvement of central nervous system in adult patients with acute myeloid leukemia
T2 - Incidence and impact on outcome
AU - Del Principe, Maria Ilaria
AU - Buccisano, Francesco
AU - Soddu, Stefano
AU - Maurillo, Luca
AU - Cefalo, Mariagiovanna
AU - Piciocchi, Alfonso
AU - Consalvo, Maria Irno
AU - Paterno, Giovangiacinto
AU - Sarlo, Chiara
AU - De Bellis, Eleonora
AU - Zizzari, Annagiulia
AU - De Angelis, Gottardo
AU - Fraboni, Daniela
AU - Divona, Mariadomenica
AU - Voso, Maria Teresa
AU - Sconocchia, Giuseppe
AU - Del Poeta, Giovanni
AU - Lo-Coco, Francesco
AU - Arcese, William
AU - Amadori, Sergio
AU - Venditti, Adriano
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Incidence and effect on outcome of central nervous system (CNS) involvement in adult patients with acute myeloid leukemia (AML) is not clearly defined. To address this issue, 103 consecutive adult patients with newly diagnosed AML, regardless of neurologic symptoms, were submitted to a routine explorative lumbar puncture. Cerebrospinal fluid (CSF) samples were collected from 65 males and 38 females. All 103 CSF samples were examined by conventional cytology (CC) whereas 95 (92%) also by flow cytometry (FCM). At diagnosis, 70 patients (68%) were CNS negative (CNS−), whereas 33 (32%) were CNS positive (CNS+). In 11 of 33 (33%), CNS infiltration was documented either by CC or FCM, in 21 (67%) only by FCM. CNS positivity was significantly associated with a M4-M5 phenotype of the underlying AML (P =.0003) and with high levels of lactate dehydrogenase (P =.006). Overall, 80 of 103 (78%) achieved complete remission with no significant differences between CNS+ and CNS− patients. Five-year disease-free survival and overall survival were found to be shorter in CNS+ patients than in those CNS− (18% vs 50%, P =.006 and 19% vs 46%, P =.02, respectively). In multivariate analysis, CNS status and age were found to affect independently overall survival. In conclusion, the incidence of CNS involvement in adult patients with newly diagnosed AML is higher than expected. Regardless of neurologic symptoms, it should always be searched at diagnosis; CSF samples should routinely be investigated by FCM since a certain proportion of CNS involvements might remain undetected if examination is exclusively CC based.
AB - Incidence and effect on outcome of central nervous system (CNS) involvement in adult patients with acute myeloid leukemia (AML) is not clearly defined. To address this issue, 103 consecutive adult patients with newly diagnosed AML, regardless of neurologic symptoms, were submitted to a routine explorative lumbar puncture. Cerebrospinal fluid (CSF) samples were collected from 65 males and 38 females. All 103 CSF samples were examined by conventional cytology (CC) whereas 95 (92%) also by flow cytometry (FCM). At diagnosis, 70 patients (68%) were CNS negative (CNS−), whereas 33 (32%) were CNS positive (CNS+). In 11 of 33 (33%), CNS infiltration was documented either by CC or FCM, in 21 (67%) only by FCM. CNS positivity was significantly associated with a M4-M5 phenotype of the underlying AML (P =.0003) and with high levels of lactate dehydrogenase (P =.006). Overall, 80 of 103 (78%) achieved complete remission with no significant differences between CNS+ and CNS− patients. Five-year disease-free survival and overall survival were found to be shorter in CNS+ patients than in those CNS− (18% vs 50%, P =.006 and 19% vs 46%, P =.02, respectively). In multivariate analysis, CNS status and age were found to affect independently overall survival. In conclusion, the incidence of CNS involvement in adult patients with newly diagnosed AML is higher than expected. Regardless of neurologic symptoms, it should always be searched at diagnosis; CSF samples should routinely be investigated by FCM since a certain proportion of CNS involvements might remain undetected if examination is exclusively CC based.
KW - Acute myeloid leukemia
KW - Central nervous system disease
KW - Conventional cytology
KW - Flow cytometry
KW - Outcome
UR - http://www.scopus.com/inward/record.url?scp=85043500487&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85043500487&partnerID=8YFLogxK
U2 - 10.1053/j.seminhematol.2018.02.006
DO - 10.1053/j.seminhematol.2018.02.006
M3 - Article
AN - SCOPUS:85043500487
JO - Seminars in Hematology
JF - Seminars in Hematology
SN - 0037-1963
ER -