Significance of lymphoblasts in cerebrospinal fluid in newly diagnosed pediatric acute lymphoblastic malignancies with bone marrow involvement: Possible benefit of dexamethasone

Abstract

We analyzed retrospectively the data on 135 children treated since 1983 for acute lymphoblastic leukaemia and non-Hodgkin's lymphoma with bone marrow involvement with respect to the presence of lymphoblasts in cerebrospinal fluid (CSF) and the number of cells in CSF, both at initial diagnosis and during follow-up. Of these children 96, 11, and 28 suffered from B-progenitor, mature B cell, and T-cell malignancies respectively. In two patients initial central nervous system involvement was documented by the presence of lymphoblasts with high CSF cell counts (B+C+ patients); 19 patients had CSF lymphoblasts with normal CSF cell counts (B+C- patients); the others had no CSF blasts and normal CSF cell counts (B-C- patients). In B+C- and B-C- patients 5-year-leukaemia-free survival was 66 and 70%, respectively (i.e., not significantly different). None of the B+C- patients experienced a first relapse in the central nervous system. Differences in outcome by comparing with reports of others may be related to the use of dexamethasone instead of prednisone in almost all of our patients.