Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
Hematology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
Semin Hematol. 2018 Oct;55(4):209-214. doi: 10.1053/j.seminhematol.2018.02.006. Epub 2018 Feb 21.
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.
中枢神经系统（CNS）受累对成人急性髓系白血病（AML）患者结局的影响尚不清楚。为解决这一问题，对 103 例新诊断的 AML 成年患者（不论有无神经系统症状）进行了常规腰椎穿刺。从 65 例男性和 38 例女性患者中采集脑脊液（CSF）样本。103 例 CSF 样本均经常规细胞学（CC）检查，95 例（92%）还经流式细胞术（FCM）检查。诊断时，70 例（68%）患者 CNS 阴性（CNS-），33 例（32%）患者 CNS 阳性（CNS+）。33 例 CNS+患者中，11 例（33%）经 CC 或 FCM 证实存在 CNS 浸润，21 例（67%）仅经 FCM 证实存在 CNS 浸润。CNS 阳性与 AML 基础疾病 M4-M5 表型（P =.0003）和乳酸脱氢酶水平升高（P =.006）显著相关。103 例患者中，80 例（78%）达到完全缓解，CNS+和 CNS-患者之间无显著差异。CNS+患者无疾病生存和总生存均短于 CNS-患者（18%比 50%，P =.006 和 19%比 46%，P =.02）。多因素分析显示，CNS 状态和年龄独立影响总生存。总之，新诊断 AML 成年患者 CNS 受累的发生率高于预期。不论有无神经系统症状，诊断时均应进行检查；CSF 样本应常规进行 FCM 检查，因为如果仅基于 CC 检查，可能会漏诊一定比例的 CNS 受累。
