Blasts in CSF with a normal cell count do not justify alteration of therapy for acute lymphoblastic leukemia in remission: A Childrens Cancer Group study

D. G. Tubergen, J. W. Cullen, J. M. Boyett, G. S. Gilchrist, R. T. O'Brien, P. F. Coccia, M. J. Waskerwitz

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Abstract

Purpose: The Childrens Cancer Group (CCG) requires both a CSF WBC count of more than five cells per microliter and demonstration of blast cells in the cytocentrifuge specimen to support a diagnosis of CNS relapse. We reviewed the CSF examinations of patients with intermediate-risk acute lymphoblastic leukemia (ALL) to determine the clinical significance of blast cells reported in the cytocentrifuge when the total CSF cell count was normal. Patients and Methods: Children treated on CCG-105 for ALL had CSF examinations every 12 weeks during maintenance therapy. The outcome of children who had a positive CSF cytocentrifuge examination without an elevated CSF WBC count was compared with that of children who did not have any CSF blast cells observed. Results: Sixty-four patients had 81 CSF examinations with blast cells and a normal cell count. By Cox life-table regression analysis, patients with blasts had a different disease-free survival (DFS) distribution, with relapses tending to occur earlier (P = .008). However, the DFS for these patients was 63% ± 9.6% at 5 years from the time of the abnormal cytocentrifuge result as compared with 69% ± 1.5% for 1,490 children who did not have blasts in their CSF. This difference is not significant. Conclusion: Blast cells were infrequently identified in cytocentrifuge preparations of CSF when the cell count was normal. The majority of patients in whom such an event was observed have not experienced a subsequent relapse as measured by life-table analysis at 5 years. The data do not justify changing or augmenting therapy based on cytocentrifuge results alone.

Original languageEnglish (US)
Pages (from-to)273-278
Number of pages6
JournalJournal of Clinical Oncology
Volume12
Issue number2
DOIs
Publication statusPublished - Feb 1994

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ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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