Odom L F, Wilson H, Cullen J, Bank J, Blake M, Jamieson B
Division of Oncology/Hematology, Children's Hospital, University of Colorado Health Sciences Center, Denver.
Cancer. 1990 Oct 15;66(8):1748-54. doi: 10.1002/1097-0142(19901015)66:8<1748::aid-cncr2820660818>3.0.co;2-e.
The purpose of this study was to determine whether the presence of more than 5% blasts in a differential count of cytocentrifuged cerebrospinal fluid (CSF) with less than 6 leukocytes/microliter was predictive of central nervous system (CNS) relapse in children with acute lymphoblastic leukemia (ALL). A double concentrate method of cytocentrifuge preparation was used to analyze 4543 consecutive CSF specimens from 349 children with ALL between January 1, 1982, and September 30, 1988. One hundred nine CSF specimens from 58 evaluable children had less than 6 leukocytes/microliter and more than 5% blasts on cytocentrifuge differential count (low-cell-count specimen with blasts [LCB]). During the study period, 25 of 332 evaluable children (7.5%) had CNS leukemic recurrence. In 22 of 25 (88%), the CNS relapse was preceded by at least one abnormal low-cell-count CSF specimen. One of 34 patients with a single LCB at diagnosis (3%) had subsequent CNS relapse compared with five of eight patients (62.5%) with a single LCB during remission (P = 0.0002). Of 16 children with two or more LCB during remission, nine (56%) had CNS relapse defined by standard criteria, whereas six additional patients in this group were declared to be in CNS relapse on the basis of their repetitive LCB. Whether diagnosing CNS recurrence earlier in its course based on a modification of the definition of CNS leukemia will change the frequency of subsequent adverse events or make possible decreased intensity of CNS retreatment remains to be determined.
本研究的目的是确定在细胞离心脑脊液（CSF）白细胞计数低于6个/微升且原始细胞比例超过5%的情况下，是否可预测急性淋巴细胞白血病（ALL）患儿的中枢神经系统（CNS）复发。采用双浓缩细胞离心制备方法，对1982年1月1日至1988年9月30日期间349例ALL患儿的4543份连续CSF标本进行分析。58例可评估患儿的109份CSF标本白细胞计数低于6个/微升，细胞离心分类计数时原始细胞比例超过5%（低细胞计数伴原始细胞的标本[LCB]）。在研究期间，332例可评估患儿中有25例（7.5%）发生CNS白血病复发。在25例中的22例（88%）中，CNS复发之前至少有一份异常的低细胞计数CSF标本。诊断时单一LCB的34例患者中有1例（3%）随后发生CNS复发，而缓解期单一LCB的8例患者中有5例（62.5%）发生CNS复发（P = 0.0002）。缓解期有两份或更多LCB的16例患儿中，9例（56%）根据标准标准被判定为CNS复发，而该组另外6例患者根据其重复性LCB被判定为CNS复发。基于对CNS白血病定义的修改在病程早期诊断CNS复发是否会改变随后不良事件的发生率或是否可能降低CNS再治疗的强度仍有待确定。
