Sancho et al identified risk factors for central nervous system (CNS) involvement in patients with acute lymphoblastic leukemia (ALL). These can help identify a patient with a poor prognosis who may benefit from more aggressive management. The authors are from the Programa para el Estudio y Tratamiento de Hemopatias Malignas Group in Spain.
Patient selection: age >= 15 years
Phenotypes of ALL:
(1) early pre-B
(2) common
(3) pre-B
(4) mature B
(5) T
Risk factors for CNS involvement at initial presentation:
(1) testicular involvement (odds ratio 9.5)
(2) mature B cell subtype or T cell type (odds ratios 28 and 8 respectively)
Risk factors for CNS involvement during a recurrence:
(1) serum LDH > 1,000 IU/L (odds ratio 6)
where:
• The upper limit of the normal reference range for LDH and the methodology were not listed.
CNS prophylaxis consists of:
(1) intrathecal methotrexate, cytarabine and hydrocortisone, AND
(2) high dose systemic methotrexate and cytarabine
