leukemia Central nervous system leukemia in ...

From bloodjournal.hematologylibrary.org by guest on July 10, 2011. For personal use only.

1985 66: 1062-1067

Central nervous system leukemia in children with acute nonlymphoblastic leukemia CH Pui, GV Dahl, DK Kalwinsky, AT Look, J Mirro, RK Dodge and JV Simone

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From bloodjournal.hematologylibrary.org by guest on July 10, 2011. For personal use only.

Central

Nervous

By Ching-Hon

System Leukemia Nonlymphoblastic

Pui, Gary V. DahI, David

in Children Leukemia

K. Kalwinsky,

with

A. Thomas

Look,

Acute

Joseph

Mirro,

Richard K. Dodge, and Joseph V. Simone Factors

contributing

system

to the

(CNS)

involvement were

of

this

determined

in

leukemia

who

clinical

trials.

three

dren

the

CNS

intrathecal

rad

with

to

an

have

initial

considered

CNS

Despite

duration

of

a

we have and

oped

it as the

has

ANLL

and

as

optimal

the

used

treat

method

had

site

of

leukemia

of first

at

relapse.

most

patients

with

ANLL,

with

features

predicting

but

a CNS

diagnosis

The

is effective

for

results

may

be

the

children or

suggest

preventive

devel-

that

therapy

inadequate

(AML-76

1983

at

nosed

for

St

leukemic

Jude

and

Research

Leukemia-Lymphoma

for those

relapse.

Hospital,

Supported National ment

Cancer

Syrian

dren’s

Institute,

Associated

Address

by grant

and

Submitted

Jan reprint

Research

Human Charities /8,

1985; requests

Hospital,

Nos. National Services,

to Dr 332

by Grune

CA2I

765 and

Childrens

Institutes and

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esterase. Bone three months

(CSF)

Ching-Hon

N Lauderdale,

27,

DepartLebanese

1985. Pui, P0

& Stratton.

Inc.

1976 ANLL

after

marrow during

aspirates treatment

were or cry-

study

of bone

periodic and

cyto-

according

to mar-

acid-Schiff

naphthol

esterase

diag-

and

classified

Wright’s-Giemsa, acetate

was

marrow

morphological

were

criteria”

a-naphthyl

clinical

to October

promyelocytic,

by

types

untreated

the bone

B, myeloperoxidase,

by at least

of increased there

St

Jude

Chil-

Box

318.

Mem-

two

intracranial

was

AS-D

a-naphthyl

chloroabutyrate

were examined routinely or at any time relapse

every was

containing

leukemic

later.

was

CSF

leukemic blasts were identisamples of cerebrospinal

observers,

when

pressure

a nonhemorrhagic

puted tomography. ie, the CSF was

and

there

cranial

were

clinical

nerve

intracerebral

mass

palsy,

disclosed

signs or when by com-

If the cellular morphology was questionable contaminated by blood (>10 erythrocytes/L) blasts,

a second

examined

sample

at diagnosis

was

and

obtained

each

time

informed The

two

In brief,

induction

therapy

vincristine

( 1.5

(1 50 mg/rn2 cm,

consent

mg/m2),

a lumbar

protocols

used

and for

administered

to all patients

described remission

(25

Monthly

vincristine, and Late

and

in remission

mg/m2),

x 3), and cytarabine

cytarabine therapy.

methotrexate,

been study,9

daunorubicin

( I 5 g/m2

weekly

continuation

have

AML-76

of weekly

6-azauridine

trials

for all patients.

in the

x 4) for up to six weeks.

vincristine,

bicin

treatment

consisted

(prednisone, cessation

obtained

for patients

cyclophospharnide, were

was

or

a few days

when

puncture was performed to instill intrathecal methotrexate. All investigations were approved by the institution’s clinical

rine April

with

black

esterase,

elsewhere.”0 the

Health.

by the American

determined Cell (FAB)

doxorubi-

6-mercaptopu-

intensive

therapy

6-mercaptopurine)

on months

was

3 1 and

32 before

of chemotherapy.

In the AML-80

0006-4971/85/6605--0008$03.00/0

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phis. TN38101. 1 985

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Memphis.

inpart

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Division.

monocytoid,

stained

Sudan

with

to two

Hospital.

myeloid, as

admitted

January

infiltrating

French-American-British smears

from

Research

examination.

previously

were

of the cells

differentiation,

chemical

consecutive ANLL

AML-80)9”#{176}

showed

patients

AND METHODS

with

Children’s

>25%

Treatment. the

of age

for

indicate

Inc.

eighty-seven and

when

committee; From

& Stratton,

years

trials

fluid

report