Johnston et al identified risk factors for an isolated CNS relapse in a pediatric patient with acute myeloid leukemia (AML). These can help identify a patient who may require closer monitoring or more aggressive management. The authors are from Children's Hospital of Eastern Ontario, University of Southern California Los Angeles, Children's Hospital of Philadelphia and Emory University.
Patient selection:
(1) pediatric patient with de novo AML
(2) complete remission after 2 cycles (1 course) of chemotherapy
Parameters at initial diagnosis:
(1) age
(2) hepatomegaly
(3) splenomegaly
(4) CNS disease at time of the initial diagnosis
(5) FAB (French-American-British) type of AML
(6) WBC count
(7) chromosome studies
Parameter
Finding
Points
age of the patient
<= 2 years of age
1
> 2 years of age
0
hepatomegaly
absent
0
present
1
splenomegaly
absent
0
present
1
CNS involved at diagnosis
absent
0
present
1
FAB type of AML
M5
1
other
0
WBC count
low (median 19,000 per µL)
0
high (median 79,000 per µL)
1
chromosome abnormality
none
0
chromosome 11 abnormality
1
other
0
number of risk factors for an isolated CNS relapse =
= SUM(points for each parameter)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 7
• The risk of CNS relapse increases with the number of risk factors.
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