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)



• 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

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