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Cerebrospinal fluid flow cytometry and risk of central nervous system relapse after hyperCVAD in adults with acute lymphoblastic leukemia.
Garcia, Kelsey-Leigh A; Cherian, Sindhu; Stevenson, Philip A; Martino, Christen H; Shustov, Andrei R; Becker, Pamela S; Percival, Mary-Elizabeth M; Oehler, Vivian G; Halpern, Anna B; Walter, Roland B; Orozco, Johnnie J; Keel, Siobán B; Estey, Elihu H; Cassaday, Ryan D.
Afiliación
  • Garcia KA; Department of Medicine, University of Washington, Seattle, Washington.
  • Cherian S; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington.
  • Stevenson PA; Clinical Statistics Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
  • Martino CH; Department of Biostatistics, University of Washington, Seattle, Washington.
  • Shustov AR; Department of Medicine, University of Washington, Seattle, Washington.
  • Becker PS; Seattle Cancer Care Alliance, Seattle, Washington.
  • Percival MM; Department of Medicine, University of Washington, Seattle, Washington.
  • Oehler VG; Seattle Cancer Care Alliance, Seattle, Washington.
  • Halpern AB; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
  • Walter RB; Department of Medicine, University of Washington, Seattle, Washington.
  • Orozco JJ; Department of Medicine, University of California Irvine, Irvine, California.
  • Keel SB; Department of Medicine, University of Washington, Seattle, Washington.
  • Estey EH; Seattle Cancer Care Alliance, Seattle, Washington.
  • Cassaday RD; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Cancer ; 128(7): 1411-1417, 2022 04 01.
Article en En | MEDLINE | ID: mdl-34931301
BACKGROUND: Potential involvement of the central nervous system (CNS) by acute lymphoblastic leukemia is typically evaluated by a conventional cytospin (CC) of cerebrospinal fluid (CSF). Multiparameter flow cytometry (MFC) is generally more sensitive and specific than morphology, but data to guide its use versus CC are limited. METHODS: This study identified 92 patients who had MFC performed on their initial CSF specimen and received at least 4 cycles of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and cytarabine (hyperCVAD) as their initial treatment. RESULTS: Eighteen (20%) were CSF+ by MFC at the baseline, and only 6 of these patients were positive by CC. In contrast, 0 of 51 patients who were negative by MFC and had CC available were positive by CC. Despite the receipt of significantly more intra-CSF chemotherapy (P < .001), the cumulative incidence of CNS relapse by MFC was 22% among CSF+ patients versus 5% among those who were CSF- (P = .044). No such association was observed between CNS relapse and CC results (P = .42). None of the 74 CSF- patients became CSF+ during their initial treatment despite being tested a median of 5 times (range, 2-10). CSF positivity by MFC was the factor most strongly associated with CNS relapse in a series of univariate Cox models (hazard ratio, 3.7; P = .067). The initial CSF status by MFC had no significant impact on overall or event-free survival. CONCLUSIONS: MFC of CSF is superior to CC of CSF in identifying adults at high risk for CNS relapse after treatment with hyperCVAD. Surveillance of CSF by MFC has limited utility.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Leucemia-Linfoma Linfoblástico de Células Precursoras Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Humans Idioma: En Revista: Cancer Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Leucemia-Linfoma Linfoblástico de Células Precursoras Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Humans Idioma: En Revista: Cancer Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos