Department of Hematology and Oncology, Shenzhen Children's Hospital, No.7019 Yitian Road, Futian District, Shenzhen, China.
Department of Hematology and Oncology, Shenzhen Children's Hospital of China Medical University, Shenzhen, China.
BMC Pediatr. 2024 Mar 22;24(1):204. doi: 10.1186/s12887-024-04684-4.
Central nervous system leukemia (CNSL) is one of the major causes of the poor prognosis of childhood leukemia. We aimed to compare the sensitivity of cytomorphology (CM) and flow cytometry (FCM) in diagnosing CNSL, emphasizing the importance of FCM in the diagnosis process.
One-hundred-sixty-five children with newly diagnosed B-cell Acute Lymphoblastic Leukemia (B-cell ALL) were included in this study. Cerebrospinal fluid (CSF) samples were taken for routine CSF analysis, CM analysis, and FCM examination. Computed tomography scans and/or magnetic resonance imaging were performed at diagnosis. Patients with CNS2, CNS3, and traumatic lumbar puncture (TLP) at diagnosis received two additional courses of triple intrathecal injections during induction treatment. We compared the sensitivity of FCM and CM in the diagnosis of children with CNSL.
One hundred and twenty-eight (77.58%) CSF samples were negative by either CM or FCM (CM/FCM), four (2.42%) were positive by both CM and FCM (CM/FCM), and thirty-three (20%) displayed a single positive finding by FCM (CM/FCM) (p = 0.044). By adding two intrathecal injections in the induction treatment, ten children with TLP had no CNS relapse, like those with TLP. However, compared to CNS1 and TLP, the event-free survival (EFS) did not significantly improve in patients with CNS2 and CNS3. Moreover, CNSL status was associated with worse 3-year EFS (p < 0.05).
We have validated that FCM is more accurate in stratifying the status of the CNS compared to CM analysis. However, to improve the EFS rate of childhood leukemia, it is necessary to combine CM examination, FCM, and cranial imaging for the early diagnosis of CNSL.
中枢神经系统白血病（CNSL）是儿童白血病预后不良的主要原因之一。本研究旨在比较细胞形态学（CM）和流式细胞术（FCM）在诊断 CNSL 中的敏感性，强调 FCM 在诊断过程中的重要性。
本研究纳入 165 例新诊断的 B 细胞急性淋巴细胞白血病（B-cell ALL）患儿。采集脑脊液（CSF）样本进行常规 CSF 分析、CM 分析和 FCM 检查。在诊断时进行计算机断层扫描和/或磁共振成像。在诱导治疗期间，对诊断为 CNS2、CNS3 和创伤性腰椎穿刺（TLP）的患者进行了另外两次三联鞘内注射。我们比较了 FCM 和 CM 在诊断 CNSL 儿童中的敏感性。
128 例（77.58%）CSF 样本 CM 或 FCM 均为阴性（CM/FCM），4 例（2.42%）CM 和 FCM 均为阳性（CM/FCM），33 例（20%）FCM 单阳性（CM/FCM）（p=0.044）。在诱导治疗中增加两次鞘内注射后，10 例 TLP 患儿无 CNS 复发，与 TLP 患儿相似。然而，与 CNS1 和 TLP 相比，CNS2 和 CNS3 患者的无事件生存（EFS）并未显著改善。此外，CNSL 状态与 3 年 EFS 较差相关（p<0.05）。
我们已经验证了与 CM 分析相比，FCM 更准确地分层 CNS 状态。然而，为了提高儿童白血病的 EFS 率，有必要结合 CM 检查、FCM 和颅成像，以早期诊断 CNSL。
