Initial Traumatic LP Adversely Affects Outcome in ALL

Abstract

Hematology-Oncology| March 01 2001 Initial Traumatic LP Adversely Affects Outcome in ALL AAP Grand Rounds (2001) 5 (3): 24. https://doi.org/10.1542/gr.5-3-24 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Initial Traumatic LP Adversely Affects Outcome in ALL. AAP Grand Rounds March 2001; 5 (3): 24. https://doi.org/10.1542/gr.5-3-24 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: blast cells, cerebrospinal fluid, leukemia, lipopolysaccharides, traumatic lumbar puncture, treatment outcome, van der woude syndrome, acute lymphocytic leukemia, atypical, central nervous system dysfunction Source: Gajjar A, Harrison PL, Sandlund JT, et al. Traumatic lumbar puncture at diagnosis adversely affects outcome in childhood acute lymphoblastic leukemia. Blood. 2000;96: 3381–3384 This retrospective study was conducted to answer an important, controversial question: does a traumatic lumbar puncture (TLP) at the time of the initial diagnostic work-up and/or induction treatment have any effect on the treatment outcome in children with acute lymphoblastic leukemia (ALL)? The authors reviewed the cerebrospinal fluid (CSF) findings of lumbar punctures (LP) performed in 546 patients enrolled on two consecutive therapeutic trials at St. Jude Children’s Research Hospital, Memphis, Tennessee between 1984 to 1991. All patients underwent 2 LPs, usually within 24–48 hrs of each other at the time of initial diagnostic evaluation and at the beginning of the induction chemotherapy. A complete blood count and examination of a centrifuged and stained CSF cell pellet were performed in all patients. The patients were divided into 5 groups depending on their central nervous system (CNS) status: LP not traumatic with <10 red blood cells (RBCs) per μL in the CNS and no leukemic blast cells (n=336), LP not traumatic with <5 white blood cells (WBCs) per μL and containing leukemic blast cells (n=80), LP not traumatic with ≥5 WBCs per μL and containing leukemic blast cells (n=16), LP traumatic with ≥10 RBCs per μL and no leukemic blast cells (TLP−, n=54), and LP traumatic with leukemic blast cells (TLP+, n=60). There were 26 patients who had 2 consecutive TLPs with blast cells (TLP++). The 5-year event-free survival (EFS± 1 SE) for the 5 groups is shown in the tableT1: The EFS was similar between patients with an atraumatic LP and no blast cells and those who were TLP− (P=.85). The EFS of patients who were TLP+ was worse than that for those who had an atraumatic LP with no blast cells (P=.026) and comparable to those who had an atraumatic LP with <5 WBCs and leukemic blast cells (P=.59). The authors conclude that a TLP during initial diagnostic evaluation and treatment of ALL leads to contamination of the CSF with circulating leukemic blast cells and will adversely affect the treatment outcome of children with ALL. Furthermore, the EFS of patients with 2 TLPs with blast cells (TLP++) was comparable to that of patients with overt CNS disease (≥5 WBCs with blast cells). The definition of CNS leukemia is controversial when the CSF contains a small number of WBCs and blasts are seen on a stained cytospin preparation. Most physicians follow the recommendation of the Rome Leukemia Workshop,1 which characterizes patients who have >5 WBCs μL with identifiable blasts as having CNS involvement. The problem is positively identifying the few “atypical” looking cells as true blasts, thus justifying more intensive CNS directed therapy. This is true even if more specific tests such as determination of surface markers by staining or flow cytometry... You do not currently have access to this content.