Dagdemir A, Ertem U, Duru F, Kirazli S
Sami Ulus Children's Hospital Department of Pediatric Oncology, Ankara, Turkey.
Leuk Lymphoma. 1998 Jan;28(3-4):391-8. doi: 10.3109/10428199809092695.
Soluble L-selectin was determined in the CSF samples of 20 children with CNS leukemia at the time they had blasts in CSF and/or clinical findings of CNS involvement; 17 CSF fluid samples were obtained from 17 of these 20 children, 29-91 days before the appearance of CSF cytological and/or clinical findings of CNS involvement; while 15 CSF samples were withdrawn from among the same group of children, after treatment of meningeal leukemia. In addition, CSF sL-selectin was also assayed in 17 children with ALL, who remained in complete remission at least for a year and, as controls, in 12 children without malignant or meningeal disorders. There was no significant difference in CSF sL-selectin levels between the children with ALL without evidence of meningeal involvement and the controls (1.34 +/- 0.21 ng/ml, 1.46 +/- 0.18 ng/ml respectively, p > 0.05). However, in children with CNS leukemia, not only at the time CNS involvement was diagnosed, but also 29-91 days before the diagnosis of CNS leukemia, the concentrations of the CSF sL-selectin (12.41 +/- 2.14 ng/ml, 7.70 +/- 1.60 ng/ml respectively) were significantly higher than those in controls (p < 0.001 and p < 0.01 respectively). After treatment and disappearance of the blasts in CSF, sL-selectin was found to be decreased and even normalized in the majority of children who had meningeal involvement (2.87 +/- 2.14 ng/ml). In 5 children, the CSF sL-selectin remained high, after the blasts in CSF had disappeared and CNS leukemia recurred within 3 months in 4 of these 5 children. In conclusion, assay of sL-selectin in CSF seems to be a good diagnostic tool in the detection of CNS involvement in children with ALL. This method may also be used as an indicator, in prediction of the CNS leukemia, which is going to develop.
在20例中枢神经系统白血病患儿脑脊液中出现原始细胞和/或有中枢神经系统受累临床表现时，测定其可溶性L-选择素水平；从这20例患儿中的17例获取了17份脑脊液样本，时间为脑脊液细胞学和/或中枢神经系统受累临床表现出现前29 - 91天；同时，从同一组患儿中抽取了15份脑脊液样本，这些样本是在脑膜白血病治疗后获取的。此外，还对17例至少已完全缓解一年的急性淋巴细胞白血病（ALL）患儿测定了脑脊液可溶性L-选择素（sL-选择素）水平，并以12例无恶性疾病或脑膜疾病的患儿作为对照。无脑膜受累证据的ALL患儿与对照组的脑脊液sL-选择素水平无显著差异（分别为1.34±0.21 ng/ml和1.46±0.18 ng/ml，p>0.05）。然而，中枢神经系统白血病患儿不仅在中枢神经系统受累诊断时，而且在中枢神经系统白血病诊断前29 - 91天，脑脊液sL-选择素浓度（分别为12.41±2.14 ng/ml和7.70±1.60 ng/ml）均显著高于对照组（分别为p<0.001和p<0.01）。在脑脊液中原始细胞经治疗消失后，大多数有脑膜受累的患儿sL-选择素水平降低甚至恢复正常（2.87±2.14 ng/ml）。5例患儿脑脊液中原始细胞消失后sL-选择素仍维持在较高水平，其中4例在3个月内复发中枢神经系统白血病。总之，测定脑脊液sL-选择素似乎是检测ALL患儿中枢神经系统受累的良好诊断工具。该方法还可作为预测即将发生的中枢神经系统白血病的指标。
