Abstract
Recent reports have indicated that elevated CSF levels of B2m in AL patients may precede the cytologic diagnosis of central nervous system (CNS) involvement. This prompted us to reevaluate the CSF B2m levels obtained on 42 AL patients at CHM during the years 1974-1975. All but 3 had acute lymphoblastic leukemia (ALL) 36 ALL children were receiving CNS prophylaxis consisting of intrathecal (IT) Methotrexate (MTX) and fractional radiation to the CNS (IMFRA) given at 10 wks. intervals. CSF was obtained at the time of administration of IT MTX either for prophylaxis or for overt CNS relapse. The level of B2m in the CNS prophylaxis group (36) varied from 0.4 to 3.65 mg/I (x 1.55 mg ± .79). 4 had elevated levels of B2m (>3 mg/l,x +2SD) at a time when CSF was free of leukemic cells. Three eventually developed CNS leukemia 2 mos., 8 mos., and 4 yrs. later. The CSF B2m level at the time of overt CNS relapse in 6 AL children varied from 0.93 - 5 mg/1 (x 3.18 ± 1.78). This differed significantly (p: <.001) from the CNS prophylaxis group. B2m level was > 3 mg/1 in 5/6. These data confirm the prior observations of others that CSF B2m levels are elevated during CNS relapse. Thus elevated levels may indicate impending relapse. Prophylactic IT MTX in itself does not appear to significantly alter the normal CSF B2m levels.
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