TY - JOUR
T1 - Incidence of and risk factors for involvement of the central nervous system in acute myeloid leukemia
AU - Rozovski, Uri
AU - Ohanian, Maro
AU - Ravandi, Farhad
AU - Garcia-Manero, Guillermo
AU - Faderl, Stefan
AU - Pierce, Sherry
AU - Cortes, Jorge
AU - Estrov, Zeev
N1 - Funding Information:
Th is work was supported in part by the National Institutes of Health through the M. D. Anderson Cancer Center’s Support Grant, P30 CA016672.
Publisher Copyright:
© 2014 Informa UK, Ltd.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - It is thought that the low incidence of central nervous system (CNS) involvement in acute myeloid leukemia (AML) does not justify routine CNS prophylaxis, as high-dose cytarabine eliminates CNS disease. To investigate whether chemotherapy that does not include high-dose cytarabine increases the risk of CNS involvement, the medical records of 1412 newly diagnosed patients with AML were reviewed. In 1370 patients, lumbar puncture (LP) was performed only if clinically indicated, and CNS disease was detected in 45 (3.3%) patients. Another 42 patients underwent routine LP as part of an investigational protocol, and in eight (19%) CNS disease was detected (p < 0.0001). Risk factors included high lactate dehydrogenase, African-American ethnicity and young age. Patients receiving high-dose cytarabine and those who did not had similar rates of CNS involvement. Disease-free survival (DFS) and overall survival were shorter in patients with CNS involvement. It remains to be determined whether routine CNS prophylaxis would improve DFS.
AB - It is thought that the low incidence of central nervous system (CNS) involvement in acute myeloid leukemia (AML) does not justify routine CNS prophylaxis, as high-dose cytarabine eliminates CNS disease. To investigate whether chemotherapy that does not include high-dose cytarabine increases the risk of CNS involvement, the medical records of 1412 newly diagnosed patients with AML were reviewed. In 1370 patients, lumbar puncture (LP) was performed only if clinically indicated, and CNS disease was detected in 45 (3.3%) patients. Another 42 patients underwent routine LP as part of an investigational protocol, and in eight (19%) CNS disease was detected (p < 0.0001). Risk factors included high lactate dehydrogenase, African-American ethnicity and young age. Patients receiving high-dose cytarabine and those who did not had similar rates of CNS involvement. Disease-free survival (DFS) and overall survival were shorter in patients with CNS involvement. It remains to be determined whether routine CNS prophylaxis would improve DFS.
KW - Acute myeloid leukemia
KW - Central nervous system
KW - Cytarabine
KW - Lumbar puncture
KW - Risk factors
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U2 - 10.3109/10428194.2014.953148
DO - 10.3109/10428194.2014.953148
M3 - Article
C2 - 25110819
AN - SCOPUS:84932107275
SN - 1042-8194
VL - 56
SP - 1392
EP - 1397
JO - Leukemia and Lymphoma
JF - Leukemia and Lymphoma
IS - 5
ER -