99 CEREBRAL FLUID NEOPTERIN LEVELS IN CHILDREN WITH MENINGEAL RELAPSE OF MALIGNANT HEMOPATHY

Abstract

Cerebrospinal fluid (CSF) neopterin concentrations were measured by HPLC in 44 normal children and 15 children affected by meningeal relapse of malignant hemopathy (13 acute lymphoblastic leukemia and 2 high grade lymphoma). When meningeal relapse was diagnosed, all the patients had CSF neopterin levels higher than the mean normal value + 2 SD, but no correlation was observed between CSF neopterin and blast count. In 10 children, CSF data before relapse were available : CSF neopterin at time of initial diagnosis of the hemopathy was 29.4 ± 12 nmol/l (median = 32.8) and 104.2 ± 56 (median = 85.6) when meningeal relapse (p < 0.01, Wilcoxon test). In 3 patients, elevation of CSF neopterin preceded (15 to 30 days) the occurrence of neurological signs or presence of blast cells in CSF. In absence of infectious context, a rise of CSF neopterin is an indicator of cerebral active phase of the malignant hemopathy. Such increase can reflect a cell mediated immunologic process induced by leukemic cells. The measure of CSF neopterin appears helpful in the monitoring of patients with malignant hemopathy to detect early meningeal relapse.