Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Pediatr Blood Cancer. 2022 Aug;69(8):e29585. doi: 10.1002/pbc.29585. Epub 2022 Feb 11.
Central nervous system (CNS) relapse in pediatric acute lymphoblastic leukemia (ALL) patients is uncommon. The cerebrospinal fluid (CSF) of patients with ALL is routinely sampled at each intrathecal chemotherapy treatment to screen for CNS relapse. The analysis of CSF is both time consuming and resource intensive and must be completed approximately 20 times per patient throughout treatment. Our objective was to examine the expense of routine screening on all CSF samples for CNS relapse in ALL patients, and to identify if CNS relapse can be detected clinically.
We identified all patients diagnosed with ALL at the Children's Hospital of Eastern Ontario (CHEO) between January 2001 and June 2021. We collected the total number of CSF samples in these patients and the number of CSF samples positive for CNS relapse. An in-depth chart review on the patients who relapsed in the CNS was completed to identify symptoms at relapse.
Over the study period, 351 patients were diagnosed with ALL and underwent a total of 6515 lumbar punctures (LPs), each of which examined the CSF. The cost of CSF sample analysis is $14.32 (Canadian dollars [CDN]); thus, the total cost for the study sample was $93,294.80 (CDN). There were 14 CNS relapses and although symptoms including headache, vomiting, and fatigue were common, two patients were asymptomatic at relapse.
Given the marginal cost of routine CSF screening and the lack of specific and sensitive symptoms for CNS relapse, we conclude that the routine practice of sending all CSF samples for analysis of CNS relapse in ALL patients is relatively inexpensive and beneficial.
小儿急性淋巴细胞白血病（ALL）患者的中枢神经系统（CNS）复发较为罕见。ALL 患者的脑脊液（CSF）在每次鞘内化疗时都要进行常规取样，以筛查 CNS 复发。CSF 的分析既耗时又耗费资源，在整个治疗过程中，每个患者大约需要完成 20 次。我们的目的是检查 ALL 患者所有 CSF 样本进行 CNS 复发常规筛查的费用，并确定是否可以通过临床检测到 CNS 复发。
我们确定了 2001 年 1 月至 2021 年 6 月期间在东安大略省儿童医院（CHEO）诊断为 ALL 的所有患者。我们收集了这些患者的 CSF 样本总数以及 CSF 样本中 CNS 复发阳性的数量。对 CNS 复发的患者进行了深入的图表审查，以确定复发时的症状。
在研究期间，351 名患者被诊断为 ALL，并总共进行了 6515 次腰椎穿刺（LP），每次都检查了 CSF。CSF 样本分析的成本为 14.32 加元（CAD）；因此，研究样本的总成本为 93294.80 CAD。有 14 例 CNS 复发，尽管头痛、呕吐和疲劳等症状很常见，但有 2 例患者复发时无症状。
鉴于常规 CSF 筛查的边际成本以及 CNS 复发缺乏特异性和敏感症状，我们得出结论，常规将所有 CSF 样本用于 ALL 患者 CNS 复发分析的做法相对便宜且有益。
