Characteristics of central nervous system invasion in acute lymphoblastic leukemia: five-year experience in two centers in Mexico City
DOI:
https://doi.org/10.35509/01239015.860Keywords:
Precursor cell lymphoblastic leukemia-lymphoma, recurrence, central nervous system, injections, spinalAbstract
Introduction: Central nervous system (CNS) invasion or infiltration can occur at diagnosis and during follow-up. Factors such as hyperleukocytosis, T phenotype, t(1;19), or traumatic punctures increase the risk. The results with intrathecal treatment are variable and require a combination with systemic chemotherapy or radiotherapy. The association with bone marrow invasion worsens the prognosis.
Objectives: This study describes the characteristics of cases with acute lymphoblastic leukemia (ALL) and CNS infiltration in patients treated at two reference centers in Mexico.
Methods: Retrospective, observational study in adult patients with ALL and CNS infiltration at diagnosis or during follow-up, detected by cytomorphology or flow cytometry.
Results: The study included 30 patients; 73.3% were men. The mean age was 29 years (17 to 57 years); 86.70% (n=26) corresponded to patients at high risk of relapse, mostly with phenotype B (93.3%). The diagnosis was made by cytomorphology in 70% and flow cytometry in 26.70%. The main symptom was headache (56.70%), and 10% had some peripheral neuropathy. The median time to relapse was 417 days; 66.70% (n=20) achieved a favorable response to intensive intrathecal chemotherapy twice a week, and 33.30% (n=10) received a combination with other strategies. CNS infiltration in less than 400 days was associated with a worse prognosis.
Conclusion: CNS infiltration is an expected complication that requires rapid resolution to prevent bone marrow relapse.
Author Biographies
Christian Omar Ramos-Peñafiel, Departamento de Hematología, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México, México.
1. Departamento de Hematología, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México, México.
Daniela Pérez-Sámano, Departamento de Hematología, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México, México.
1. Departamento de Hematología, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México, México.
Irma Olarte-Carrillo, Laboratorio de Biología Molecular, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México, México.
2. Laboratorio de Biología Molecular, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México, México.
Adán Germán Gallardo-Rodríguez, Departamento de Investigación en Hematología, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México, México
3. Departamento de Investigación en Hematología, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México, México.
Rafael Cerón-Maldonado, Laboratorio de Biología Molecular, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México, México.
2. Laboratorio de Biología Molecular, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México, México.
Adolfo Martínez-Tovar, Laboratorio de Biología Molecular, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México, México.
2. Laboratorio de Biología Molecular, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México, México.
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