CNS relapse in children with acute lymphoblastic leukemia after cranial prophylaxis
Pai, S.K.; Koppikar, S.B.; Sanchetee, S.C.; Pai, V.R.; Kurkure, P.A.; Choudhary, A.J.; Shetty, P.A.
Indian Journal of Cancer 25(3): 165-171
1988
ISSN/ISBN: 0019-509X PMID: 3224988 Document Number: 325107
This is a retrospective analysis of 368 children newly diagnosed with Acute Lymphoblastic Leukemia (ALL) between the years 1974 and 1980. Of these, 168 children were considered for analysis. After they attained complete remission they were given conventional cranial pophylaxis with cranial irradiation and intrathecal methotrexate. Eventually, ten patients developed CNS leukemia during maintenance phase within a variable period of 1.5 to 25 months after cranial prophylaxis. Salvage therapy was only temporarily effective in eight patients. The other two patients were lost to follow-up. On analysis a high initial WBC count at presentation was the single most important factor contributing to CNS relapse. Organomegaly and thrombocytopaenia were additional factors. The role of the immunological cell-type may be an important contributory factor but in the six present series this investigation was not done routinely. The incidence of CNS relapse of six percent in this series is acceptable as it is comparable with the trends reported in world literature.