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Liu J, Wang Y, Sun X, Liu S, Yu Z, Ji N, Sun S, Liu Y. Lesions of the central nervous system in leukemia: Pathological and magnetic resonance imaging features at presentation in 14 patients. Oncol Lett 2017; 14:8162-8170. [PMID: 29344259 DOI: 10.3892/ol.2017.7192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 01/26/2017] [Indexed: 10/18/2022] Open
Abstract
The present study aimed to characterize the specific pathology and magnetic resonance imaging (MRI) findings observed in patients with leukemia with central nervous system (CNS) lesions, and to determine their value in the management of such patients. Lesions of the CNS were observed during and following treatment of leukemia. The data from stereotactic biopsy-proven pathology (12 patients) and MRI examinations (14 patients) were retrospectively evaluated. Proton-magnetic resonance-spectroscopy was performed in three patients. Factors that predisposed to lesions of the CNS were reviewed from the patient medical records. Among the 14 patients, eight had CNS leukemia, four had a CNS infection and two had a neurodegenerative disorder (one leukoencephalopathy and one glial cell hyperplasia). The clinical diagnosis based on clinical symptoms, signs and MRI features was not consistent with the pathological diagnosis in two patients. In one patient, the clinical diagnosis was a CNS infection; however, the patient's pathological diagnosis was CNS leukemia. In the other patient, the clinical diagnosis was CNS leukemia, but the pathological diagnosis was glial cell hyperplasia. CNS lesions in leukemia have a wide range of causes. Apart from the relapse of leukemia in the CNS, there are treatment-associated neurotoxicities and infections that are caused by immunocompromised states. As numerous leukemia-associated CNS lesions are treatable, early diagnosis is essential.
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Affiliation(s)
- Jing Liu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Yaming Wang
- Department of Neurosurgery, Navy General Hospital, Beijing 100048, P.R. China
| | - Xuefei Sun
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Shuo Liu
- Duke Clinical Research Institute, Duke University, Durham, NC 27705, USA
| | - Zhenkun Yu
- Department of Otorhinolaryngology, Head and Neck Surgery, Nanjing Tongren Hospital, Southeast University, Nanjing 211100, P.R. China
| | - Nan Ji
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Shengjun Sun
- Neuroimaging Center, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Yuanbo Liu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
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O'Dwyer KM, Liesveld JL. Philadelphia chromosome negative B-cell acute lymphoblastic leukemia in older adults: Current treatment and novel therapies. Best Pract Res Clin Haematol 2017; 30:184-192. [DOI: 10.1016/j.beha.2017.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
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Clement JM, Holle LM. Safe Administration of Intracerebral Spinal Fluid Chemotherapy: Time for Guidelines. J Oncol Pract 2017; 13:713-718. [PMID: 28850310 DOI: 10.1200/jop.2017.022038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jessica M Clement
- University of Connecticut Health, Farmington; and University of Connecticut School of Pharmacy, Storrs, CT
| | - Lisa M Holle
- University of Connecticut Health, Farmington; and University of Connecticut School of Pharmacy, Storrs, CT
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Vadillo E, Dorantes-Acosta E, Pelayo R, Schnoor M. T cell acute lymphoblastic leukemia (T-ALL): New insights into the cellular origins and infiltration mechanisms common and unique among hematologic malignancies. Blood Rev 2017; 32:36-51. [PMID: 28830639 DOI: 10.1016/j.blre.2017.08.006] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/08/2017] [Accepted: 08/12/2017] [Indexed: 02/06/2023]
Abstract
T-cell acute lymphoblastic leukemia (T-ALL) accounts for 15% and 25% of total childhood and adult ALL cases, respectively. During T-ALL, patients are at risk of organ infiltration by leukemic T-cells. Infiltration is a major consequence of disease relapse and correlates with poor prognosis. Transendothelial migration of leukemic cells is required to exit the blood stream into target organs. While mechanisms of normal T-cell transmigration are well known, the mechanisms of leukemic T-cell extravasation remain elusive; but involvement of chemokines, integrins and Notch signaling play critical roles. Here, we summarize current knowledge about molecular mechanisms of leukemic T-cell infiltration with special emphasis on the newly identified subtype early T-cell-progenitor (ETP)-ALL. Furthermore, we compare the extravasation potential of T-ALL cells with that of other hematologic malignancies such as B-ALL and acute myeloid leukemia (AML).
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Affiliation(s)
- Eduardo Vadillo
- Department for Molecular Biomedicine, Centre for Investigation and Advanced Studies of the National Polytechnic Institute (Cinvestav-IPN), 07360 Mexico City, Mexico.
| | - Elisa Dorantes-Acosta
- Leukemia Clinic, Children's Hospital of Mexico Federico Gómez, 06720 Mexico City, Mexico
| | - Rosana Pelayo
- Oncology Research Unit, National Medical Center, Mexican Institute for Social Security, 06720 Mexico City, Mexico
| | - Michael Schnoor
- Department for Molecular Biomedicine, Centre for Investigation and Advanced Studies of the National Polytechnic Institute (Cinvestav-IPN), 07360 Mexico City, Mexico.
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García-Recio M, Cladera A, Bento L, Dominguez J, Ruiz de Gracia S, Sartori F, Del Campo R, García L, Ballester C, Gines J, Bargay J, Sampol A, Gutiérrez A. Analysis of the role of intratecal liposomal cytarabine in the prophylaxis and treatment of central nervous system lymphomatosis: The Balearic Lymphoma Group experience. PLoS One 2017; 12:e0179595. [PMID: 28665999 PMCID: PMC5493300 DOI: 10.1371/journal.pone.0179595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 06/01/2017] [Indexed: 01/18/2023] Open
Abstract
Central nervous system (CNS) lymphomatosis is a fatal complication of aggressive non-Hodgkin lymphoma (NHL). In lymphoblastic or Burkitt lymphoma, without specific CNS prophylaxis the risk of CNS relapse is 20–30%. DLBCL has a lower risk of relapse (around 5%) but several factors increase its incidence. There is no consensus or trials to conclude which is the best CNS prophylaxis. Best results seem to be associated with the use of intravenous (iv) high-dose methotrexate (HDMTX) but with a significant toxicity. Other options are the administration of intrathecal (IT) MTX, cytarabine or liposomal cytarabine (ITLC). Our aim is to analyze the experience of the centers of the Balearic Lymphoma Group (BLG) about the toxicity and efficacy of ITLC in the prophylaxis and therapy of CNS lymphomatosis. We retrospectively reviewed cases from 2005 to 2015 (n = 58) treated with ITLC. Our toxicity results were: 33% headache, 20% neurological deficits, 11% nausea, 9% dizziness, 4% vomiting, 4% fever, 2% transient blindness and 2% photophobia. In the prophylactic cohort (n = 26) with a median follow-up of 55 months (17–81) only 3 CNS relapses (11%) were observed (testicular DLBCL, Burkitt and plasmablastic lymphoma, with a cumulative incidence of 8%, 14% and 20% respectively). In the treatment cohort (n = 32), CSF complete clearance was obtained in 77% cases. Median OS was 6 months (0–16). Death causes were lymphoma progression (19 patients, 79%), treatment toxicity (2 patients) and non-related (3 patients, 12%). Toxicity profile was good especially when concomitant dexamethasone was administered. In the prophylactic cohort the incidence of CNS relapse in DLBCL group was similar to previously reported for HDMTX and much better than IT MTX. A high number of ITLC injections was associated with better rates of CSF clearance, clinical responses, PFS and lower relapses. Survival is still poor in CNS lymphomatosis and new therapeutic approaches are still needed.
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Affiliation(s)
- Marta García-Recio
- Hematology department, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Antonia Cladera
- Hematology department, Hospital Son Llatzer, Palma de Mallorca, Balearic Islands, Spain
| | - Leyre Bento
- Hematology department, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Julia Dominguez
- Hematology department, Hospital Son Llatzer, Palma de Mallorca, Balearic Islands, Spain
| | - Silvia Ruiz de Gracia
- Hematology department, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Francesca Sartori
- Hematology department, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Raquel Del Campo
- Hematology department, Hospital Son Llatzer, Palma de Mallorca, Balearic Islands, Spain
| | - Lucia García
- Hematology department, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Carmen Ballester
- Hematology department, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Jordi Gines
- Pharmacy department, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Joan Bargay
- Hematology department, Hospital Son Llatzer, Palma de Mallorca, Balearic Islands, Spain
| | - Antonia Sampol
- Hematology department, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Antonio Gutiérrez
- Hematology department, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain
- * E-mail:
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Abstract
The central nervous system (CNS) is an important site of involvement by acute lymphoblastic leukemia (ALL) in adults. The prevalence is sufficiently high that prophylactic treatment is routinely given to this sanctuary site in order to eradicate occult disease that might otherwise lead to a relapse. A lumbar puncture should be routinely performed in all newly diagnosed patients with ALL. The risks of CNS leukemia vary by phenotype and genotype. Preventive treatment of the CNS during post-remission therapy has become an integral part of all current ALL treatment protocols. Most treatment regimens combine multiple doses of intrathecal chemotherapy with high-dose systemic methotrexate and/or cytarabine. Cranial irradiation is less commonly used for prophylaxis but is still the most effective treatment for overt CNS leukemia. Recurrences within the CNS usually coincide with or predict soon afterwards for systemic relapse in the marrow and blood.
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Affiliation(s)
- Richard A Larson
- a Department of Medicine, Section of Hematology/Oncology, and Comprehensive Cancer Center , The University of Chicago , Chicago , IL , USA
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Winick N, Devidas M, Chen S, Maloney K, Larsen E, Mattano L, Borowitz MJ, Carroll A, Gastier-Foster JM, Heerema NA, Willman C, Wood B, Loh ML, Raetz E, Hunger SP, Carroll WL. Impact of Initial CSF Findings on Outcome Among Patients With National Cancer Institute Standard- and High-Risk B-Cell Acute Lymphoblastic Leukemia: A Report From the Children's Oncology Group. J Clin Oncol 2017; 35:2527-2534. [PMID: 28535084 DOI: 10.1200/jco.2016.71.4774] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To determine the prognostic significance of blasts, and of white and red blood cells, in CSF samples at diagnosis of acute lymphoblastic leukemia (ALL), a uniform CSF and risk group classification schema was incorporated into Children's Oncology Group B-cell ALL (B-ALL) clinical trials. Methods CSF status was designated as follows: CNS1, no blasts; CNS2a to 2c, < 5 WBCs/μL and blasts with/without ≥ 10 RBCs/μL or ≥ 5 WBCs/μL plus blasts, with WBCs ≥ 5 times the number of RBCs; CNS3a to 3c, ≥ 5 WBCs/μL plus blasts with/without ≥ 10 RBCs/μL or clinical signs of CNS disease. CNS2 status did not affect therapy; patients with CNS3 status received two extra intrathecal treatments during induction and augmented postinduction therapy with 18 Gy of cranial radiation. Results Among 8,379 evaluable patients enrolled from 2004 to 2010, 7,395 (88.3%) had CNS1 status; 857 (10.2%), CNS2; and 127 (1.5%), CNS3. The 5-year event-free and overall survival rates were, respectively, 85% and 92.7% for CNS1, 76% and 86.8% for CNS2, and 76% and 82.1% for CNS3 ( P < .001). In multivariable analysis that included age, race/ethnicity, initial WBC, and day-29 minimal residual disease < 0.1%, CSF blast, regardless of cell count, was an independent adverse predictor of outcome for patients with standard- or high-risk disease according to National Cancer Institute criteria. The EFS difference reflected a significant difference in the incidence of CNS, not marrow, relapse in patients with CNS1 versus CNS2 and/or CNS3 status. Conclusion Low levels of CNS leukemia, regardless of RBCs, predict inferior outcome and higher rates of CNS relapse. These data suggest that additional augmentation of CNS-directed therapy is warranted for CNS2 disease.
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Affiliation(s)
- Naomi Winick
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Meenakshi Devidas
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Si Chen
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Kelly Maloney
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Eric Larsen
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Leonard Mattano
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Michael J Borowitz
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Andrew Carroll
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Julie M Gastier-Foster
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Nyla A Heerema
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Cheryl Willman
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Brent Wood
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Mignon L Loh
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Elizabeth Raetz
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Stephen P Hunger
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - William L Carroll
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
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Clinical characteristics of patients with central nervous system relapse in BCR-ABL1-positive acute lymphoblastic leukemia: the importance of characterizing ABL1 mutations in cerebrospinal fluid. Ann Hematol 2017; 96:1069-1075. [PMID: 28451802 PMCID: PMC5486784 DOI: 10.1007/s00277-017-3002-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/14/2017] [Indexed: 12/11/2022]
Abstract
We investigated the frequency, predictors, and evolution of acute lymphoblastic leukemia (ALL) in patients with CNS relapse and introduced a novel method for studying BCR-ABL1 protein variants in cDNA from bone marrow (BM) and cerebrospinal fluid (CSF) blast cells. A total of 128 patients were analyzed in two PETHEMA clinical trials. All achieved complete remission after imatinib treatment. Of these, 30 (23%) experienced a relapse after achieving complete remission, and 13 (10%) had an isolated CNS relapse or combined CNS and BM relapses. We compared the characteristics of patients with and without CNS relapse and further analyzed CSF and BM samples from two of the 13 patients with CNS relapse. In both patients, classical sequencing analysis of the kinase domain of BCR-ABL1 from the cDNA of CSF blasts revealed the pathogenic variant p.L387M. We also performed ultra-deep next-generation sequencing (NGS) in three samples from one of the relapsed patients. We did not find the mutation in the BM sample, but we did find it in CSF blasts with 45% of reads at the time of relapse. These data demonstrate the feasibility of detecting BCR-ABL1 mutations in CSF blasts by NGS and highlight the importance of monitoring clonal evolution over time.
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Hypoxic adaptation of leukemic cells infiltrating the CNS affords a therapeutic strategy targeting VEGFA. Blood 2017; 129:3126-3129. [PMID: 28424164 DOI: 10.1182/blood-2016-06-721712] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Liang Y, Ding L, Li X, Wang W, Zhang X. Oculomotor nerve palsy as a preceding symptom of adult sporadic Burkitt lymphoma: A case report and review of the literature. Oncol Lett 2017; 13:1315-1318. [PMID: 28454254 DOI: 10.3892/ol.2017.5583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 08/19/2016] [Indexed: 12/21/2022] Open
Abstract
Adult sporadic Burkitt lymphoma (BL) is a rare aggressive neoplasm and represents ~1-5% of all lymphomas diagnosed in adults. The disease exhibits an aggressive clinical manifestation, which frequently involves the central nervous system (CNS) in the early stages, and is usually accompanied by abnormalities in cerebrospinal fluid (CSF) examinations and/or neuroradiography. The current study describes the rare case of a 29-year-old man who presented with oculomotor nerve palsy without palpated masses, B symptoms, peripheral blood anomaly and abnormalities of the nervous system. The patient was initially misdiagnosed with abducens diplopia, but was subsequently confirmed to have BL with early CNS invasion. Epstein-Barr virus and human immunodeficiency virus infection were negative. Intensive systemic chemotherapy with hyperfractionated cyclophosphamide, vincristine, therarubicin and dexamethasone (hyper-CVAD, cyclophosphamide 600 mg/m2 on days 2-4; vincristine 1.4 mg/m2 on days 5 and 12, therarubicin 50 mg/m2 on day 5 and dexamethasone 40 mg on days 2-5 and 12-15), including intrathecal chemotherapy with methotrexate (5 mg), arabinocytidine (5 mg) and dexamethasone (5 mg), was determined as an appropriate treatment. Rituximab (375 mg/m2 on day 1) was administered alongside chemotherapy to increase treatment efficacy. The patient temporarily underwent complete remission, but subsequently relapsed as no suitable bone marrow donor was available. Adult sporadic BL with early CNS invasion, which traditional tests such as neuroradiography and CSF examination fail to identify, is uncommon. Therefore, appropriate diagnostic tests are critical for accurate diagnosis and must be performed immediately, particularly in patients that present with unusual image and laboratory manifestations.
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Affiliation(s)
- Yun Liang
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Luyin Ding
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Xian Li
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Weiqin Wang
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Xiaohong Zhang
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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Gossai NP, Gordon PM. The Role of the Central Nervous System Microenvironment in Pediatric Acute Lymphoblastic Leukemia. Front Pediatr 2017; 5:90. [PMID: 28491865 PMCID: PMC5405081 DOI: 10.3389/fped.2017.00090] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/10/2017] [Indexed: 12/11/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) is the most common cancer in children. While survival rates for ALL have improved, central nervous system (CNS) relapse remains a significant cause of treatment failure and treatment-related morbidity. Accordingly, there is a need to identify more efficacious and less toxic CNS-directed leukemia therapies. Extensive research has demonstrated a critical role of the bone marrow (BM) microenvironment in leukemia development, maintenance, and chemoresistance. Moreover, therapies to disrupt mechanisms of BM microenvironment-mediated leukemia survival and chemoresistance represent new, promising approaches to cancer therapy. However, in direct contrast to the extensive knowledge of the BM microenvironment, the unique attributes of the CNS microenvironment that serve to make it a leukemia reservoir are not yet elucidated. Recent work has begun to define both the mechanisms by which leukemia cells migrate into the CNS and how components of the CNS influence leukemia biology to enhance survival, chemoresistance, and ultimately relapse. In addition to providing new insight into CNS relapse and leukemia biology, this area of investigation will potentially identify targetable mechanisms of leukemia chemoresistance and self-renewal unique to the CNS environment that will enhance both the durability and quality of the cure for ALL patients.
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Affiliation(s)
- Nathan P Gossai
- Division of Pediatric Hematology and Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Peter M Gordon
- Division of Pediatric Hematology and Oncology, University of Minnesota, Minneapolis, MN, USA.,University of Minnesota Masonic Cancer Center, Minneapolis, MN, USA
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Ranta S, Palomäki M, Levinsen M, Taskinen M, Abrahamsson J, Mellgren K, Niinimäki R, Schmiegelow K, Heyman M, Harila-Saari A. Role of neuroimaging in children with acute lymphoblastic leukemia and central nervous system involvement at diagnosis. Pediatr Blood Cancer 2017; 64:64-70. [PMID: 27555087 DOI: 10.1002/pbc.26182] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/09/2016] [Accepted: 07/12/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Each year approximately 200 children and adolescents are diagnosed with acute lymphoblastic leukemia (ALL) in the five Nordic countries, and 3% of these have central nervous system (CNS) involvement confirmed by leukemic cells in the cerebrospinal fluid (CSF) or neurological symptoms. We sought to determine the significance of neuraxis imaging in such patients. PROCEDURE Magnetic resonance images of children aged 1-17.9 with CNS leukemia at diagnosis of ALL were centrally reviewed and clinical data were retrieved from the medical records and the Nordic leukemia registry. Patients were diagnosed in the period 2000-2012 in Sweden, Finland, or Denmark. RESULTS The cohort comprised 1,877 patients, and 66 (3.5%) had CNS involvement. Forty-five percent (30/66) had CNS related symptoms. Symptoms included vomiting, facial palsy, headache, visual symptoms, and impaired hearing. CNS imaging was performed in 32 of 66 children (48%), and confirmed CNS involvement in 6 of 21 patients with symptoms (29%) and 5 of 11 (45%) without (P = 0.44). There was no difference in the overall survival between CNS-positive patients with and without signs of leukemic involvement by imaging (P = 0.53). CONCLUSIONS Radiological imaging of asymptomatic children with CNS leukemia at diagnosis lacks clinical importance, but may be useful in patients with cranial nerve symptoms and negative CSF, as well as for follow-up. Imaging of symptomatic patients is warranted in order to exclude other causes underlying the symptoms.
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Affiliation(s)
- Susanna Ranta
- Astrid Lindgren Children's Hospital, Karolinska University Hospital and Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden
| | - Maarit Palomäki
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Mette Levinsen
- Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mervi Taskinen
- Children and Adolescents Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Jonas Abrahamsson
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Mellgren
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Riitta Niinimäki
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Medicine, The Institute of Gynecology, Obstetrics, and Pediatrics, University of Copenhagen, Denmark
| | - Mats Heyman
- Astrid Lindgren Children's Hospital, Karolinska University Hospital and Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden
| | - Arja Harila-Saari
- Astrid Lindgren Children's Hospital, Karolinska University Hospital and Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden
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Central Nervous System Involvement at the Time of Allogeneic Hematopoietic Stem Cell Transplantation Is Associated with a Poor Outcome in Patients with Acute Myeloid Leukemia. Pathol Oncol Res 2016; 23:433-437. [PMID: 28004352 DOI: 10.1007/s12253-016-0162-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
Abstract
Recent reports suggested that central nervous system (CNS) involvement (CNS+) in patients with acute myeloid leukemia (AML) before allogeneic hematopoietic stem cell transplantation (allo-HSCT) is not an independent predictor of survival after allo-HSCT. However, these studies did not analyze minimal residual disease in the CNS at the time of allo-HSCT. We evaluated the effect of residual CNS+ on the transplant outcomes of 214 AML patients in a single institution. Twenty-one (10%) patients were diagnosed with CNS+ prior to allo-HSCT. Of these, 13 patients had CNS disease at the time of allo-HSCT. The patients in CNS+ AML remission at the time of allo-HSCT had better overall survival (OS) than the patients who were not in remission (2-year OS: 55% vs. 7.7%, p = 0.0001). In multivariate analyses, CNS+ at the time of allo-HSCT (hazard ratio (HR), 1.9; 95% confidence interval (CI), 1.05-3.59; p = 0.04), age over 50 years at the time of allo-HSCT, and non-complete remission disease status in bone marrow at the time of allo-HSCT were independent adverse factors for OS. However, a prior history of CNS+ before allo-HSCT did not independently affect OS (HR, 1.27; 95% CI 0.53-2.07; p = 0.6). Early diagnosis and eradication of CNS+ at the time of allo-HSCT may be necessary to improve the outcome for patients with CNS+ AML.
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Efficacy and Toxicity of Intrathecal Liposomal Cytarabine in First-line Therapy of Childhood Acute Lymphoblastic Leukemia. J Pediatr Hematol Oncol 2016; 38:602-609. [PMID: 27571129 DOI: 10.1097/mph.0000000000000642] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We investigated efficacy and toxicity of replacing conventional triple (cytarabine, methotrexate, and hydrocortisone) intrathecal therapy (TIT) with liposomal cytarabine during maintenance therapy among 40 acute lymphoblastic leukemia patients. Twenty-eight of 29 patients in the TIT arm received TIT and 9/11 in the liposomal cytarabine arm received liposomal cytarabine. Arachnoiditis occurred in all initial 5 patients given liposomal cytarabine and intrathecal prednisolone succinate. Subsequently liposomal cytarabine was given with systemic dexamethasone. Neurotoxicity occurred at 6/27 liposomal cytarabine administrations with concomitant dexamethasone (22%). More liposomal cytarabine-treated patients experienced neurotoxicity in relation to intrathecal therapy during at least 1 cycle compared with TIT-treated patients (6/9 [67%] vs. 3/28 [11%], P=0.002). Apart from intermittent lower extremity sensory pain in 1 liposomal cytarabine-treated patient, no permanent adverse neurological sequelae were observed. In intention-to-treat analysis, projected 5-year event-free survival (pEFS-5y) was borderline higher for patients in the liposomal cytarabine arm compared with the TIT arm (1.0 vs. 0.69, P=0.046). However, pEFS-5y and projected 5-year relapse-free survival did not differ signficantly between patients treated with liposomal cytarabine or TIT (1.0 vs. 0.73, P=0.10; 1.0 vs. 0.76, P=0.12). Larger prospective trials are needed to explore whether liposomal cytarabine should be used as first-line prevention of relapse.
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Levinsen M, Marquart HV, Groth-Pedersen L, Abrahamsson J, Albertsen BK, Andersen MK, Frandsen TL, Harila-Saari A, Pronk C, Ulvmoen A, Vaitkevičienė G, Lähteenmäki PM, Niinimäki R, Taskinen M, Jeppesen M, Schmiegelow K. Leukemic blasts are present at low levels in spinal fluid in one-third of childhood acute lymphoblastic leukemia cases. Pediatr Blood Cancer 2016; 63:1935-42. [PMID: 27447373 DOI: 10.1002/pbc.26128] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/30/2016] [Accepted: 06/08/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Central nervous system (CNS) involvement is associated with relapse in childhood acute lymphoblastic leukemia (ALL) and is a diagnostic challenge. PROCEDURE In a Nordic/Baltic prospective study, we assessed centralized flow cytometry (FCM) of locally fixed cerebrospinal fluid (CSF) samples versus local conventional cytospin-based cytology (CC) for detecting leukemic cells and evaluating kinetics of elimination of leukemic cells in CSF. RESULTS Among 300 patients with newly diagnosed ALL, 87 (29%) had CSF involvement by FCM, while CC was positive in 30 (10%) of 299 patients with available CC data (P < 0.001). Patients with FCM+/CC+ had higher CSF leukemic blast counts compared to patients positive by FCM only (medians: 0.10 vs. 0.017 leukemic blasts/μl, P = 0.006). Patients positive by FCM had higher white blood cell counts in peripheral blood than patients negative by FCM (medians: 45 × 10(9) /l vs. 10 × 10(9) /l, P < 0.001), were younger (medians: 3 years vs. 4 years, P = 0.03), and more frequently had T-cell ALL (18/87 vs. 16/213, P = 0.001). At treatment day 15, five of 52 patients (10%) who had CSF positive by FCM at diagnosis remained so despite at least two doses of weekly intrathecal chemotherapy. CONCLUSIONS Longer follow-up is needed to clarify whether FCM positivity has prognostic significance and is an indicator for intensified CNS-directed therapy.
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Affiliation(s)
- Mette Levinsen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hanne V Marquart
- Department of Clinical Immunology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Line Groth-Pedersen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jonas Abrahamsson
- Department of Pediatrics, Institution of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Mette K Andersen
- Department of Clinical Genetics, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Thomas L Frandsen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Arja Harila-Saari
- Department of Pediatrics, Astrid Lindgrens Hospital, Stockholm, Sweden
| | - Cornelis Pronk
- Department of Pediatrics, Skåne University Hospital, Lund, Sweden
| | - Aina Ulvmoen
- Department of Pediatrics, Oslo University Hospital, Norway
| | - Goda Vaitkevičienė
- Centre for Pediatric Oncology and Hematology, University Children's Hospital, Vilnius, Lithuania
| | | | - Riitta Niinimäki
- Department of Pediatrics, Oulu University Hospital, Oulu, Finland
| | - Mervi Taskinen
- Children and Adolescents, Helsinki University Hospital, Helsinki, Finland
| | - Maria Jeppesen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
- Division of Pediatric Hematology/Oncology, Perlmutter Cancer Center, NYU Langone Medical Center, New York.
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Samara VC, de Havenon A. Rare case of T-cell lymphoma presenting as acute myelopathy. BMJ Case Rep 2016; 2016:bcr-2016-217944. [PMID: 27769981 DOI: 10.1136/bcr-2016-217944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute myelopathy is a rare presentation of systemic T-cell lymphoma. We present the case of a man aged 68 years with a diffuse erythematous maculopapular rash, followed by lower extremity paresthesias and progressive lower extremity weakness. Spinal MRI showed longitudinally extensive T2 hyperintensity with diffuse contrast enhancement. An atypical clonal T-lymphocyte population was identified in cerebrospinal fluid, peripheral blood and bone marrow aspirate, indicating a malignant T-cell lymphoproliferative disorder. The patient was treated with intrathecal and systemic chemotherapy. Unfortunately, he was not responsive to chemotherapy.
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Affiliation(s)
| | - Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
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68
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MRI Findings in Patients With Leukemia and Positive CSF Cytology: A Single-Institution 5-Year Experience. AJR Am J Roentgenol 2016; 207:1278-1282. [PMID: 27611654 DOI: 10.2214/ajr.16.16221] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The purposes of this study were to describe the spectrum of MRI findings and determine the prognostic role of MRI in adults with acute leukemia with positive CSF cytology. MATERIALS AND METHODS In this retrospective study of 34 patients (19 women, 15 men; mean age, 51 years; range, 18-72 years) treated for CNS leukemia between 2006 and 2011, 31 (91%) contrast-enhanced brain and 14 (41%) spine MRI studies were reviewed by two radiologists to note patterns of enhancement. Interobserver agreement and correlation of enhancement with outcome were analyzed. RESULTS MRI showed abnormal findings in 25 patients (74%). Pachymeningeal enhancement (n = 9/31, 29%), leptomeningeal enhancement (n = 6/31, 19%), cranial nerve enhancement (n = 9/31, 29%), masslike enhancement (n = 3/31, 10%), and spinal meningeal enhancement (n = 10/14, 71%) were identified. There was strong interobserver agreement (κ = 0.906). Survival rates were shorter to a statistically significant degree with pachymeningeal enhancement (median, 7 months; interquartile range [IQR], 5-8 months versus median, 26 months; IQR, 15 months to not reached; p = 0.004) and two or more sites of enhancement (median, 8 months; IQR, 3-13 months versus median, 19 months; IQR, 9 months to not reached; p = 0.046). CONCLUSION Brain or spine MRI examinations (or both) showed abnormal findings in nearly three-fourths of adults with acute leukemia with positive CSF cytology who were imaged for neurologic symptoms. Pachymeningeal enhancement and two or more sites of brain involvement were associated with shorter survival.
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69
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Olmos-Jiménez R, Espuny-Miró A, Díaz-Carrasco MS, Fernández-Varón E, Valderrey-Pulido M, Cárceles-Rodríguez C. Stability of four standardized preparations of methotrexate, cytarabine, and hydrocortisone for intrathecal use. J Oncol Pharm Pract 2016; 22:659-65. [DOI: 10.1177/1078155215600905] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Intrathecal administration of methotrexate, cytarabine, and hydrocortisone is commonly used to treat and prevent central nervous system involvement in leukemias and lymphomas. The use of intrathecal solutions with pH and osmolarity values close to physiologic range of CSF (pH 7.31–7.37, osmolarity 281–306 mOsm/kg) and standardization of the methotrexate, cytarabine, and hydrocortisone doses in children and adults based on age is highly recommended. Stability studies of standardized intrathecal mixtures under these conditions have not yet been published. Objective The purpose of this study was to evaluate the physical and chemical stabilities of four standardized mixtures of methotrexate, cytarabine, and hydrocortisone stored at 2–8℃ and 25℃ up to 7 days after preparation. Methods Four different standardized intrathecal mixtures were prepared and stored at 2–8℃ and 25℃ and protected from light. Triplicate samples were taken at different times and precipitation, appearance, color, pH, and osmolarity were analyzed. Methotrexate, cytarabine, and hydrocortisone concentrations were measured using a modified high-performance liquid chromatography method. Results No variation greater than 10% of the initial concentration of methotrexate, cytarabine, and hydrocortisone was observed in any of the four standardized mixtures for the 7 days of study when stored at 2–8℃ and 25℃ and protected from light. The osmolarity of the four preparations was within the physiologic range of CSF for 7 days at both 2–8℃ and 25℃. The pH values close to the physiologic range of CSF were stable for 48 h at 25℃ and for 120 h at 2–8℃. Conclusions Triple intrathecal standardized preparations of methotrexate, cytarabine, and hydrocortisone sodium phosphate are physically and chemically stable at 25℃ for 48 h and at 2–8℃ for 5 days.
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Risk-Adapted Approach to HLA-Matched Sibling Hematopoietic Cell Allografting: Impact of Adjusting Conditioning Intensity and Integrating Post-Transplant Therapeutic Interventions. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:304-10. [DOI: 10.1016/j.clml.2016.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 01/12/2016] [Accepted: 01/26/2016] [Indexed: 11/18/2022]
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Cohler C, Jumanne S, Kaijage J, DuBois SG, Scanlan P, Matthay KK. Evaluation and Outcome of Central Nervous System Involvement in Pediatric Acute Lymphoblastic Leukemia in Dar es Salaam, Tanzania. Pediatr Blood Cancer 2016; 63:458-64. [PMID: 26529141 DOI: 10.1002/pbc.25829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/04/2015] [Accepted: 10/05/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Outcomes for acute lymphoblastic leukemia (ALL) in low-income countries lag far behind high-income countries (HIC). We explored the impact of central nervous system (CNS) involvement on outcome of pediatric patients with ALL in Tanzania. PROCEDURE Comprehensive chart review was performed to characterize CNS involvement, treatment, and outcomes of pediatric patients with ALL at Muhimbili National Hospital in Dar es Salaam, Tanzania between January 1, 2011 and December 31, 2013. RESULTS One hundred fifty-six patients with confirmed ALL had accessible data, and 128 initiated therapy. Sixteen percent of 156 patients had a documented cerebral spinal fluid analysis by cytospin. Seventy patients (45%) had a documented lumbar puncture with intrathecal (IT) therapy within 1 week of diagnosis. Thirteen patients presented with CNS involvement at diagnosis based on cytospin and/or unequivocal symptoms. Twenty-one patients (16%) experienced CNS relapse, three of whom had CNS disease at diagnosis. Median event-free survival (EFS) for all patients was 7.9 months and estimated EFS at 24 months was 31%. For the patients with CNS involvement at diagnosis, the estimated EFS at 24 months was 45%. Only three of 21 patients with CNS relapse were still alive with a median follow up of 3 months. CONCLUSIONS The rate of CNS disease in patients with ALL in Dar es Salaam at diagnosis and relapse was higher than that reported in HIC, and overall survival was lower. Improving outcomes will require further advances including consistent CNS prophylaxis and may include targeting high-risk patients with additional IT treatments.
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Affiliation(s)
- Cheryl Cohler
- Department of Pediatrics, UCSF School of Medicine and UCSF Benioff Children's Hospital, University of California, San Francisco, California
| | - Shakilu Jumanne
- Department of Pediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Jane Kaijage
- Department of Pediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Steven G DuBois
- Department of Pediatrics, UCSF School of Medicine and UCSF Benioff Children's Hospital, University of California, San Francisco, California
| | - Patricia Scanlan
- Department of Pediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Katherine K Matthay
- Department of Pediatrics, UCSF School of Medicine and UCSF Benioff Children's Hospital, University of California, San Francisco, California
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Kaul S, Korgenski EK, Ying J, Ng CF, Smits‐Seemann RR, Nelson RE, Andrews S, Raetz E, Fluchel M, Lemons R, Kirchhoff AC. A retrospective analysis of treatment-related hospitalization costs of pediatric, adolescent, and young adult acute lymphoblastic leukemia. Cancer Med 2016; 5:221-9. [PMID: 26714675 PMCID: PMC4735779 DOI: 10.1002/cam4.583] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 12/14/2022] Open
Abstract
This retrospective study examined the longitudinal hospital outcomes (costs adjusted for inflation, hospital days, and admissions) associated with the treatment of pediatric, adolescent, and young adult acute lymphoblastic leukemia (ALL). Patients between one and 26 years of age with newly diagnosed ALL, who were treated at Primary Children's Hospital (PCH) in Salt Lake City, Utah were included. Treatment and hospitalization data were retrieved from system-wide cancer registry and enterprise data warehouse. PCH is a member of the Children's Oncology Group (COG) and patients were treated on, or according to, active COG protocols. Treatment-related hospital costs of ALL were examined by computing the average annual growth rates (AAGR). Longitudinal regressions identified patient characteristics associated with costs. A total of 505 patients (46.9% female) were included. The majority of patients had B-cell lineage ALL, 6.7% had T-ALL, and the median age at diagnosis was 4 years. Per-patient, first-year ALL hospitalization costs at PCH rose from $24,197 in 1998 to $37,924 in 2012. The AAGRs were 6.1, 13.0, and 7.6% for total, pharmacy, and room and care costs, respectively. Average days (AAGR = 5.2%) and admissions (AAGR = 3.8%) also demonstrated an increasing trend. High-risk patients had 47% higher costs per 6-month period in the first 5 years from diagnosis than standard-risk patients (P < 0.001). Similarly, relapsed ALL and stem cell transplantations were associated with significantly higher costs than nonrelapsed and no transplantations, respectively (P < 0.001). Increasing treatment-related costs of ALL demonstrate an area for further investigation. Value-based interventions such as identifying low-risk fever and neutropenia patients and managing them in outpatient settings should be evaluated for reducing the hospital burden of ALL.
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Affiliation(s)
| | | | - Jian Ying
- University of UtahSalt Lake CityUtah
| | - Christi F. Ng
- Tufts University School of MedicineBostonMassachusetts
| | | | | | | | - Elizabeth Raetz
- University of UtahSalt Lake CityUtah
- Primary Children's HospitalSalt Lake CityUtah
| | - Mark Fluchel
- University of UtahSalt Lake CityUtah
- Primary Children's HospitalSalt Lake CityUtah
| | - Richard Lemons
- University of UtahSalt Lake CityUtah
- Primary Children's HospitalSalt Lake CityUtah
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73
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Association between traumatic lumbar puncture and the risk of central nervous system relapse in adults with acute lymphoblastic leukaemia. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2015. [DOI: 10.1016/j.hgmx.2015.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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74
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Ranta S, Nilsson F, Harila-Saari A, Saft L, Tani E, Söderhäll S, Porwit A, Hultdin M, Noren-Nyström U, Heyman M. Detection of central nervous system involvement in childhood acute lymphoblastic leukemia by cytomorphology and flow cytometry of the cerebrospinal fluid. Pediatr Blood Cancer 2015; 62:951-6. [PMID: 25545289 DOI: 10.1002/pbc.25363] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 10/27/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Therapy directed at the central nervous system (CNS) is an essential part of the treatment for childhood acute lymphoblastic leukemia (ALL). The current evaluation of CNS involvement based on cytomorphological examination of the cerebrospinal fluid (CSF) alone is not as sensitive with low cell counts as flow cytometric immunophenotyping (FCI) of the CSF. However, the importance of low CSF blasts counts at diagnosis is uncertain. We sought to determine the significance of FCI in relation to conventional morphological examination. PROCEDURE We retrospectively compared FCI of the CSF with cytomorphology at diagnosis or relapse of childhood ALL. All patients were diagnosed 2000-2012 in Stockholm or Umeå, Sweden. Clinical data were collected from medical records and the Nordic leukemia registry. Treatment assignment was based on morphological examination only. RESULTS The cohort was comprised of 214 patients with ALL. CSF involvement was detected by both methods in 20 patients, in 17 by FCI alone, and in one patient by cytomorphology alone. The relapse rate was higher for patients with negative cytology but positive FCI compared to those without CNS involvement using both methods. The difference was especially marked in the current protocol. However, none of the patients with negative CSF cytology but positive FCI had a CNS relapse. CONCLUSIONS FCI of the CSF increased the detection rate of CNS involvement of ALL approximately two times compared to cytomorphology. Patients with low-level CNS involvement may benefit from additional intensified systemic or CNS-directed therapy, but larger studies are needed.
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Affiliation(s)
- Susanna Ranta
- Childhood Cancer Research Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
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75
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Jurczak W, Kroll-Balcerzak R, Giebel S, Machaczka M, Giza A, Ogórka T, Fornagiel S, Rybka J, Wróbel T, Kumiega B, Skotnicki AB, Komarnicki M. Liposomal cytarabine in the prophylaxis and treatment of CNS lymphoma: toxicity analysis in a retrospective case series study conducted at Polish Lymphoma Research Group Centers. Med Oncol 2015; 32:90. [PMID: 25716885 PMCID: PMC4341025 DOI: 10.1007/s12032-015-0520-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 02/13/2015] [Indexed: 12/15/2022]
Abstract
Lymphomas with primary or secondary involvement of central nervous system (CNS) have poor prognosis despite specific treatment protocols which include whole brain radiotherapy and high-dose systemic and/or intrathecal chemotherapy. Toxicity of intrathecal liposomal cytarabine-based regimens collected between November 2006 and January 2012 was assessed retrospectively. Data from 120 adult lymphoma patients with, or at high risk of CNS involvement who received intrathecal liposomal cytarabine-based regimens at six Polish Lymphoma Research Group centres between November 2006 and January 2012 were assessed retrospectively. Patients were divided into three cohorts: A (high risk of CNS disease, n = 88), B (cerebrospinal fluid pleocytosis without neurological symptoms or pathological imaging findings, n = 7), and C (CNS disease/neurological involvement; n = 25). In all examined groups, toxicity of treatment was found to be acceptable (including the prophylactic setting). None of the patients in cohorts A or B who took intrathecal liposomal cytarabine 50 mg, repeated every 2–4 weeks (mean 3.8 doses) had experienced a CNS relapse at a median follow-up time of 3 years. Patients in cohort C had a 76 % overall neurological response rate (including a 40 % complete response rate) and median overall survival of 4.8 years. Regimens incorporating liposomal cytarabine seem to be safe and effective treatments for lymphomas with CNS involvement.
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Affiliation(s)
- Wojciech Jurczak
- Department of Haematology, Jagiellonian University, 36 Kopernika str., 30-501, Kraków, Poland
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76
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Mer tyrosine kinase promotes the survival of t(1;19)-positive acute lymphoblastic leukemia (ALL) in the central nervous system (CNS). Blood 2015; 125:820-30. [DOI: 10.1182/blood-2014-06-583062] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Key Points
Mer mediates quiescence and chemotherapy resistance in a CNS coculture model and causes CNS infiltration in immunodeficient mice. Mer expression correlates with CNS positivity upon initial diagnosis in t(1;19)-positive pediatric ALL patients.
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77
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Inmunofenotipo en el líquido cefalorraquídeo de niños con leucemia linfoblástica aguda. GACETA MEXICANA DE ONCOLOGÍA 2015. [DOI: 10.1016/j.gamo.2015.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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78
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Alexander S. Clinically defining and managing high-risk pediatric patients with acute lymphoblastic leukemia. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2014; 2014:181-189. [PMID: 25696853 DOI: 10.1182/asheducation-2014.1.181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
For children with acute lymphoblastic leukemia, the identification of those at higher risk of disease recurrence and modifying therapy based on this risk is a critical component to the provision of optimal care. The specific definitions of high-risk ALL vary across cooperative groups, but the themes are consistent, being largely based on leukemia biology and disease response. Intensification of conventional chemotherapy for those with high-risk disease has led to improved outcomes. It is anticipated that the development of rational targeted therapy for specific biologically unique subsets of children with leukemia will contribute to ongoing progress in improving the outcomes for children with acute lymphoblastic anemia.
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79
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Abstract
For children with acute lymphoblastic leukemia, the identification of those at higher risk of disease recurrence and modifying therapy based on this risk is a critical component to the provision of optimal care. The specific definitions of high-risk ALL vary across cooperative groups, but the themes are consistent, being largely based on leukemia biology and disease response. Intensification of conventional chemotherapy for those with high-risk disease has led to improved outcomes. It is anticipated that the development of rational targeted therapy for specific biologically unique subsets of children with leukemia will contribute to ongoing progress in improving the outcomes for children with acute lymphoblastic anemia.
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80
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Rozovski U, Ohanian M, Ravandi F, Garcia-Manero G, Faderl S, Pierce S, Cortes J, Estrov Z. Incidence of and risk factors for involvement of the central nervous system in acute myeloid leukemia. Leuk Lymphoma 2014; 56:1392-7. [PMID: 25110819 DOI: 10.3109/10428194.2014.953148] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
It is thought that the low incidence of central nervous system (CNS) involvement in acute myeloid leukemia (AML) does not justify routine CNS prophylaxis, as high-dose cytarabine eliminates CNS disease. To investigate whether chemotherapy that does not include high-dose cytarabine increases the risk of CNS involvement, the medical records of 1412 newly diagnosed patients with AML were reviewed. In 1370 patients, lumbar puncture (LP) was performed only if clinically indicated, and CNS disease was detected in 45 (3.3%) patients. Another 42 patients underwent routine LP as part of an investigational protocol, and in eight (19%) CNS disease was detected (p < 0.0001). Risk factors included high lactate dehydrogenase, African-American ethnicity and young age. Patients receiving high-dose cytarabine and those who did not had similar rates of CNS involvement. Disease-free survival (DFS) and overall survival were shorter in patients with CNS involvement. It remains to be determined whether routine CNS prophylaxis would improve DFS.
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Affiliation(s)
- Uri Rozovski
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center , Houston, TX , USA
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81
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Levinsen M, Rosthøj S, Nygaard U, Heldrup J, Harila-Saari A, Jonsson OG, Bechensteen AG, Abrahamsson J, Lausen B, Frandsen TL, Weinshilboum RM, Schmiegelow K. Myelotoxicity after high-dose methotrexate in childhood acute leukemia is influenced by 6-mercaptopurine dosing but not by intermediate thiopurine methyltransferase activity. Cancer Chemother Pharmacol 2014; 75:59-66. [PMID: 25347948 DOI: 10.1007/s00280-014-2613-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 10/14/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Through enhancement of 6-mercaptopurine (6MP) bioavailability and inhibition of purine de novo synthesis, high-dose methotrexate (HD-MTX) may increase incorporation into DNA of 6-thioguanine nucleotides, the cytotoxic metabolites of 6MP. Patients with intermediate activity of thiopurine methyltransferase (TPMT(IA)) have higher cytosol 6-thioguanine nucleotide levels. We investigated toxicity following HD-MTX during MTX/6MP maintenance therapy in relation to 6MP and TPMT. METHODS Using linear mixed models, we explored myelo- and hepatotoxicity in relation to 6MP dosage and TPMT phenotype following 1,749 HD-MTX courses to 411 children with acute lymphoblastic leukemia on maintenance therapy. RESULTS The degree of myelosuppression following HD-MTX was similar for patients with TPMT(IA) and patients with high TPMT activity (TPMT(HA)), when HD-MTX started with same blood counts and 6MP doses. However, since TPMT(IA) had lower blood counts at initiation of HD-MTX compared with TPMT(HA) patients (median WBC 2.8 vs. 3.3 × 10⁹/L, P = 0.01; median ANC 1.4 vs. 1.7 × 10⁹/L, P = 0.02), TPMT(IA) continued to have lower WBC and ANC levels compared with TPMT(HA) during all 28 days after HD-MTX [relative difference 9 % (95 % CI 2-17), P = 0.02 and 21 % (95 % CI 6-39), P = 0.005]. Still, the fractional decrease in WBC and ANC levels after HD-MTX did not differ between TPMT(IA) and TPMT(HA) patients (P = 0.47; P = 0.38). The degree of leukopenia, neutropenia, thrombocytopenia and rise in aminotransferases were all significantly related to 6MP dose (P < 0.001 for all analyses). CONCLUSION For both TPMT(IA) and TPMT(HA) patients, dose of 6MP prior to HD-MTX should be guided by pre-HD-MTX blood counts, but not by TPMT activity.
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Affiliation(s)
- Mette Levinsen
- Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark
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82
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Masurekar AN, Parker CA, Shanyinde M, Moorman AV, Hancock JP, Sutton R, Ancliff PJ, Morgan M, Goulden NJ, Fraser C, Hoogerbrugge PM, Revesz T, Darbyshire PJ, Krishnan S, Love SB, Saha V. Outcome of central nervous system relapses in childhood acute lymphoblastic leukaemia--prospective open cohort analyses of the ALLR3 trial. PLoS One 2014; 9:e108107. [PMID: 25279465 PMCID: PMC4184796 DOI: 10.1371/journal.pone.0108107] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 08/13/2014] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED The outcomes of Central Nervous System (CNS) relapses in children with acute lymphoblastic leukaemia (ALL) treated in the ALL R3 trial, between January 2003 and March 2011 were analysed. Patients were risk stratified, to receive a matched donor allogeneic transplant or fractionated cranial irradiation with continued treatment for two years. A randomisation of Idarubicin with Mitoxantrone closed in December 2007 in favour of Mitoxantrone. The estimated 3-year progression free survival for combined and isolated CNS disease were 40.6% (25·1, 55·6) and 38.0% (26.2, 49.7) respectively. Univariate analysis showed a significantly better survival for age <10 years, progenitor-B cell disease, good-risk cytogenetics and those receiving Mitoxantrone. Adjusting for these variables (age, time to relapse, cytogenetics, treatment drug and gender) a multivariate analysis, showed a poorer outcome for those with combined CNS relapse (HR 2·64, 95% CI 1·32, 5·31, p = 0·006 for OS). ALL R3 showed an improvement in outcome for CNS relapses treated with Mitoxantrone compared to Idarubicin; a potential benefit for matched donor transplant for those with very early and early isolated-CNS relapses. TRIAL REGISTRATION Controlled-Trials.com ISRCTN45724312.
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Affiliation(s)
- Ashish Narayan Masurekar
- Children’s Cancer Group, Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer, Manchester Academic Health Science Centre, Central Manchester University Hospitals Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Catriona A. Parker
- Children’s Cancer Group, Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer, Manchester Academic Health Science Centre, Central Manchester University Hospitals Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Milensu Shanyinde
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Anthony V. Moorman
- Leukaemia Research Cytogenetics Group, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jeremy P. Hancock
- Bristol Genetics Laboratory, Southmead Hospital, Bristol, United Kingdom
| | - Rosemary Sutton
- Children’s Cancer Institute Australia, Lowy Cancer Research Centre, University of New South Wales, Sydney, Australia
| | | | - Mary Morgan
- Child Oncology and Haematology Centre, Southampton General Hospital, Southampton, United Kingdom
| | | | - Chris Fraser
- Queensland Children's Cancer Centre, Brisbane, Australia
| | - Peter M. Hoogerbrugge
- Childrens Hospital, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Dutch Childhood Oncology Group, The Hague, The Netherlands
| | - Tamas Revesz
- Department of Haematology-Oncology, SA Pathology at Women’s and Children’s Hospital and University of Adelaide, Adelaide, Australia
| | - Philip J. Darbyshire
- Department of Haematology, Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Shekhar Krishnan
- Paediatric Oncology, Tata Translational Cancer Research Centre, Kolkata, India
| | - Sharon B. Love
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Vaskar Saha
- Paediatric Oncology, Tata Translational Cancer Research Centre, Kolkata, India
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83
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Palejwala SK, Stidd DA, Skoch JM, Gupta P, Lemole GM, Weinand ME. Use of a stop-flow programmable shunt valve to maximize CNS chemotherapy delivery in a pediatric patient with acute lymphoblastic leukemia. Surg Neurol Int 2014; 5:S273-7. [PMID: 25225619 PMCID: PMC4163905 DOI: 10.4103/2152-7806.139381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 06/25/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The requirement for frequent intraventricular drug delivery in the setting of shunt dependence is particularly challenging in the treatment of central nervous system infection, neoplastic disease, and hemorrhage. This is especially relevant in the pediatric population where both hematogenous malignancy requiring intrathecal drug delivery and shunt-dependent hydrocephalus are more prevalent. Intrathecal and intraventricular chemotherapy agents can be prematurely diverted in these shunt-dependent patients. CASE DESCRIPTION We report the use of a stop-flow programmable shunt valve to maximize delivery of intraventricular chemotherapy in a child with acute lymphoblastic leukemia and disseminated intravascular coagulation who presented with spontaneous intracerebral and intraventricular hemorrhages. The patient then developed posthemorrhagic hydrocephalus and eventually progressed to shunt dependence but still required frequent intraventricular chemotherapy administration. A ventriculoperitoneal shunt, equipped with a valve that allows for near cessation of cerebrospinal fluid flow (Certas(®), Codman, Raynham, MA), and a contralateral Ommaya reservoir were inserted to maximize intraventricular dissemination of chemotherapy. CONCLUSIONS To the best of our knowledge, this is the first reported case of the use of a high-resistance programmable valve being used to virtually cease cerebrospinal fluid flow through the distal catheter temporarily in order to maximize intraventricular drug dissemination in a pediatric patient with acute lymphoblastic leukemia.
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Affiliation(s)
- Sheri K Palejwala
- Department of Surgery, Division of Neurosurgery, University of Arizona, 1501 N. Campbell Ave., Tucson, Arizona, USA
| | - David A Stidd
- Department of Surgery, Division of Neurosurgery, University of Arizona, 1501 N. Campbell Ave., Tucson, Arizona, USA
| | - Jesse M Skoch
- Department of Surgery, Division of Neurosurgery, University of Arizona, 1501 N. Campbell Ave., Tucson, Arizona, USA
| | - Puja Gupta
- Department of Pediatrics, Division of Pediatric Oncology, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, Ohio, USA
| | - G Michael Lemole
- Department of Surgery, Division of Neurosurgery, University of Arizona, 1501 N. Campbell Ave., Tucson, Arizona, USA
| | - Martin E Weinand
- Department of Surgery, Division of Neurosurgery, University of Arizona, 1501 N. Campbell Ave., Tucson, Arizona, USA
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84
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Parasole R, Petruzziello F, Messina C, Barisone E, Pession A, Locatelli F, Micalizzi C, Cesaro S, Testi AM, De Matteo A, Varotto S, Berger M, Morello W, Menna G, Poggi V. Toxicity and efficacy of intrathecal liposomal cytarabine in children with leukemia/lymphoma relapsing in the central nervous system: a retrospective multicenter study. Leuk Lymphoma 2014; 56:650-5. [PMID: 24882262 DOI: 10.3109/10428194.2014.927456] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The toxicity and efficacy of intrathecal liposomal cytarabine (LC) were evaluated in children with central nervous system (CNS) relapsed/refractory acute leukemia/lymphoma. Thirty patients (male:female ratio 21:9; median age 9.4 years) with CNS relapsed/resistant disease were treated with intrathecal LC at dosages adjusted for age. Twenty-seven (90%) patients simultaneously received systemic chemotherapy, including concurrent high-dose cytarabine or methotrexate in 21 (70%) cases. Of 28 patients evaluable for response, 25 patients (89%) achieved CNS complete remission and three (11%) partial remission. The median number of intrathecal LC administrations per patient was 4. The cerebrospinal fluid was cleared after a median of 3 intrathecal LC administrations. Neurological toxicity ≥ grade 3 occurred in four (13%) patients. No permanent sequelae were observed. The median overall survival was 20.9 months and the 5-year probability of survival was 46%. These encouraging data suggest that intrathecal LC is well tolerated and effective in children with relapsed/refractory CNS leukemia/lymphoma.
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Affiliation(s)
- Rosanna Parasole
- Department of Pediatric Hematogy-Oncology, Santobono-Pausilipon Hospital , Naples , Italy
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85
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Levinsen M, Taskinen M, Abrahamsson J, Forestier E, Frandsen TL, Harila-Saari A, Heyman M, Jonsson OG, Lähteenmäki PM, Lausen B, Vaitkevičienė G, Asberg A, Schmiegelow K. Clinical features and early treatment response of central nervous system involvement in childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2014; 61:1416-21. [PMID: 24623619 DOI: 10.1002/pbc.24981] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 01/16/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Central nervous system (CNS) involvement in childhood acute lymphoblastic leukemia (ALL) remains a therapeutic challenge. PROCEDURE To explore leukemia characteristics of patients with CNS involvement at ALL diagnosis, we analyzed clinical features and early treatment response of 744 patients on Nordic-Baltic trials. CNS status was classified as CNS1 (no CSF blasts), CNS2 (<5 leukocytes/µl CSF with blasts), CNS3 (≥5 leukocytes/µl with blasts or signs of CNS involvement), TLP+ (traumatic lumbar puncture with blasts), and TLP- (TLP with no blasts). RESULTS Patients with CNS involvement had higher leukocyte count compared with patients with CNS1 (P < 0.002). Patients with CNS3 more often had T-ALL (P < 0.001) and t(9;22)(q34;q11)[BCR-ABL1] (P < 0.004) compared with patients with CNS1. Among patients with CNS involvement headache (17%) and vomiting (14%) were most common symptoms. Symptoms or clinical findings were present among 27 of 54 patients with CNS3 versus only 7 of 39 patients with CNS2 and 15 of 75 patients with TLP+ (P < 0.001). The majority of patients with CNS involvement received additional induction therapy. The post induction bone marrow residual disease level did not differ between patients with CNS involvement and patients with CNS1 (P > 0.15). The 12-year event-free survival for patients with leukemic mass on neuroimaging did not differ from patients with negative or no scan (0.50 vs. 0.60; P = 0.7) or between patients with symptoms or signs suggestive of CNS leukemia and patients without such characteristics (0.50 vs. 0.61; P = 0.2). CONCLUSION CNS involvement at diagnosis is associated with adverse prognostic features but does not indicate a less chemosensitive leukemia.
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Affiliation(s)
- Mette Levinsen
- Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark
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86
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Castellino SM, Ullrich NJ, Whelen MJ, Lange BJ. Developing interventions for cancer-related cognitive dysfunction in childhood cancer survivors. J Natl Cancer Inst 2014; 106:dju186. [PMID: 25080574 DOI: 10.1093/jnci/dju186] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Survivors of childhood cancer frequently experience cancer-related cognitive dysfunction, commonly months to years after treatment for pediatric brain tumors, acute lymphoblastic leukemia (ALL), or tumors involving the head and neck. Risk factors for cancer-related cognitive dysfunction include young age at diagnosis, treatment with cranial irradiation, use of parenteral or intrathecal methotrexate, female sex, and pre-existing comorbidities. Limiting use and reducing doses and volume of cranial irradiation while intensifying chemotherapy have improved survival and reduced the severity of cognitive dysfunction, especially in leukemia. Nonetheless, problems in core functional domains of attention, processing speed, working memory and visual-motor integration continue to compromise quality of life and performance. We review the epidemiology, pathophysiology and assessment of cancer-related cognitive dysfunction, the impact of treatment changes for prevention, and the broad strategies for educational and pharmacological interventions to remediate established cognitive dysfunction following childhood cancer. The increased years of life saved after childhood cancer warrants continued study toward the prevention and remediation of cancer-related cognitive dysfunction, using uniform assessments anchored in functional outcomes.
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Affiliation(s)
- Sharon M Castellino
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL).
| | - Nicole J Ullrich
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
| | - Megan J Whelen
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
| | - Beverly J Lange
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
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87
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The risk of traumatic lumbar punctures in children with acute lymphoblastic leukaemia. Eur J Cancer 2014; 50:1482-9. [DOI: 10.1016/j.ejca.2014.02.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 01/21/2014] [Accepted: 02/11/2014] [Indexed: 11/18/2022]
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88
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Collie AMB, Hill BT, Stevens GHJ, Fenner K, Gazdick E, Hsi ED. Flow cytometric analysis of cerebrospinal fluid has low diagnostic yield in samples without atypical morphology or prior history of hematologic malignancy. Am J Clin Pathol 2014; 141:515-21. [PMID: 24619752 DOI: 10.1309/ajcp8ib8frqdvpxl] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To identify pretest characteristics of cerebrospinal fluid (CSF) specimens that will allow the rational use of flow cytometric analysis (FCA) in the diagnosis of hematologic malignancy. METHODS Retrospective data were collected on 501 consecutive CSF samples submitted for FCA. RESULTS A positive diagnosis of hematologic malignancy was made in 41 specimens (8.2%). Blasts or atypical lymphocytes were noted on Wright-stained slides in 98% of FCA-positive specimens (40/41), and a history of a hematologic malignancy was present in 89% of specimens (34/38). All FCA-positive specimens had atypical morphology or history of hematologic malignancy. Four hundred six specimens (81%) were FCA negative. Of FCA-negative specimens, 7% (30/406) had atypical morphology, and 3% (12/404) had future central nervous system involvement seen within 30 days. CONCLUSIONS These data support a policy in which FCA of CSF is actively discouraged unless atypical lymphocytes or blasts are seen or a history of hematologic malignancy is present.
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Affiliation(s)
- Angela M. B. Collie
- Pathology and Laboratory Medicine Institute, Department of Clinical Pathology, The Cleveland Clinic, Cleveland, OH
| | - Brian T. Hill
- Taussig Cancer Institute, Department of Hematologic Oncology and Blood Disorders, The Cleveland Clinic, Cleveland, OH
| | - Glen H. J. Stevens
- Brain Tumor and Neuro-Oncology Center, The Cleveland Clinic, Cleveland, OH
| | - Kathleen Fenner
- Taussig Cancer Institute, Department of Hematologic Oncology and Blood Disorders, The Cleveland Clinic, Cleveland, OH
| | - Elizabeth Gazdick
- Taussig Cancer Institute, Department of Hematologic Oncology and Blood Disorders, The Cleveland Clinic, Cleveland, OH
| | - Eric D. Hsi
- Pathology and Laboratory Medicine Institute, Department of Clinical Pathology, The Cleveland Clinic, Cleveland, OH
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89
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Kokolo MB, Fergusson D, O'Neill J, Tay J, Tinmouth AT, Stewart D, Bredeson C. Effectiveness and safety of thiotepa as conditioning treatment prior to stem cell transplant in patients with central nervous system lymphoma. Leuk Lymphoma 2014; 55:2712-20. [PMID: 24491026 DOI: 10.3109/10428194.2014.889825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Thiothepa is a cytostatic agent used in managing solid malignancies, and also as conditioning treatment before hematopoietic stem cell transplantation [HSCT]. This systematic review summarizes evidence on its effectiveness and safety, in patients with central nervous system [CNS] lymphoma. METHODS We searched 3 databases for clinical studies. When feasible, we performed meta-analyses. RESULTS We identified 13 eligible studies, none of which with a priori controls. So data synthesis focused on the 226 patients who received thiotepa. Based on pooled estimates, 75.9% of thiotepa-treated patients achieved a complete remission (95% confidence interval [CI] = 67.5-82.8), and 61.7% had a progression-free survival for up to 125 months post-treatment (95% CI = 49.4-72.7). However, 25.5% relapsed, 24.6% experienced infection, and 13.2% experienced neurotoxicity. DISCUSSION Thiotepa-based conditioning followed by HSCT may be effective in most CNS lymphoma patients, with a manageable toxicity profile. But adequately powered randomized trials are needed to better evaluate and isolate the effects of thiotepa.
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90
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[Differential diagnosis of lymphoid infiltrates in the central nervous system: experience of the Network Lymphomas and Lymphomatoid Lesions in the Nervous System]. DER PATHOLOGE 2014; 34:186-97. [PMID: 23471726 DOI: 10.1007/s00292-013-1742-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The differential diagnosis of lymphoid lesions in the central nervous system covers a broad spectrum of neoplastic and inflammatory disorders. Complex cases benefit from the combined expertise in the fields of hematopoietic and neuroepithelial tumors as well as neuroimmunology. The Network Lymphomas and Lymphomatoid Lesions in the Nervous System (NLLLN) recommends performing a biopsy prior to any therapeutic intervention as a precise diagnosis was impossible in approximately 50 % of patients pretreated with corticosteroids. This is based on the analysis of approximately 1,000 cases in the past 4 years. In addition to total NLLLN experiences the characteristics, pathogenesis and differential diagnosis of primary lymphoma of the central nervous system are discussed.
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91
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Klingenberg M, Becker J, Eberth S, Kube D, Wilting J. The NADPH oxidase inhibitor imipramine-blue in the treatment of Burkitt lymphoma. Mol Cancer Ther 2014; 13:833-41. [PMID: 24482381 DOI: 10.1158/1535-7163.mct-13-0688] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Burkitt lymphoma is a rare malignancy arising from B cells. Current chemotherapeutic regimens achieve excellent overall survival rates in children, but less impressive rates in adults. There are cases with poor outcome caused by toxic effects of the therapy, tumor lysis syndrome, or metastatic spread of lymphomas to the central nervous system. Modulators of reactive oxygen species are currently discussed as potential drugs for the treatment of cancer. The NADPH oxidase 4 inhibitor imipramine-blue might satisfy the aforementioned requirements, and was studied here. We used MTT assay, crystal violet assay, and thymidine 3H-incorporation assay to analyze the effects of imipramine-blue on Burkitt lymphoma (BL2, BL2B95, BL30B95, BL41B95), neuroblastoma (KELLY, SH-SY5Y, SMS-KAN), cervix carcinoma (HeLa), breast cancer (MDA-MB231), angiosarcoma (AS-M), human embryonic kidney (HEK293WT), and nonmalignant (FLP1) cell lines. The effects of imipramine-blue on BL2B95 cells in vivo were investigated in xenografts on the chick chorioallantoic membrane (CAM). We report that imipramine-blue is a potent growth inhibitor for several cancer cell lines in vitro with IC(50) values comparable to those of doxorubicin (0.16-7.7 μmol/L). Tumor size of BL2B95 cells inoculated in the CAM was reduced significantly (P < 0.05) after treatment with 10 μmol/L imipramine-blue. Lymphogenic dissemination of BL2B95 and the formation of blood and lymphatic vessels in experimental tumors were not affected. We show that imipramine-blue can be used to decrease the viability of cancer cell lines in vitro and in vivo. Imipramine-blue reduces the size of experimental Burkitt lymphoma significantly but does not affect the dissemination of BL2B95 cells, angiogenesis, and lymphangiogenesis.
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Affiliation(s)
- Marcel Klingenberg
- Authors' Affiliations: Departments of Anatomy and Cell Biology and Hematology and Oncology, University Medicine Goettingen, Goettingen, Germany
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92
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Basu SK, Remick SC, Monga M, Gibson LF. Breaking and entering into the CNS: clues from solid tumor and nonmalignant models with relevance to hematopoietic malignancies. Clin Exp Metastasis 2013; 31:257-67. [PMID: 24306183 DOI: 10.1007/s10585-013-9623-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 11/01/2013] [Indexed: 12/16/2022]
Abstract
Various malignancies invade the CNS sanctuary site, accounting for the vast majority of CNS neoplastic foci and contributing to significant morbidity as well as mortality. The blood-brain barrier (BBB) exhibits considerable impermeability to chemotherapeutic agents, severely limiting therapeutic options available for patients developing metastatic CNS involvement, accounting for poor outcomes. The mechanisms by which malignant cells breach the highly exclusive BBB and subsequently survive in this unique anatomical site remain poorly understood, with most of the current knowledge stemming from nonmalignant and solid malignancy models. While solid and hematologic malignancies may face different challenges once within the CNS (e.g., solid tumor parenchymal metastasis compared to masses/nodules/leptomeningeal disease in hematologic malignancies), commonality exists in the process of migrating across the BBB from the circulation. Specifically considering this last point, this review aims to survey the current mechanistic knowledge regarding malignant migration across the BBB, necessarily emphasizing the better studied solid tumor and nonmalignant models with the intention of highlighting both the current knowledge gap and additional work required to effectively consider how hematopoietic malignancies breach the CNS.
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Affiliation(s)
- Soumit K Basu
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program, Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV, USA,
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93
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Valentin A, Troppan K, Pfeilstöcker M, Nösslinger T, Linkesch W, Neumeister P. Safety and tolerability of intrathecal liposomal cytarabine as central nervous system prophylaxis in patients with acute lymphoblastic leukemia. Leuk Lymphoma 2013; 55:1739-42. [DOI: 10.3109/10428194.2013.853765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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94
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The incidence of secondary central nervous system involvement in patients with non-Hodgkin's lymphoma as detected by 18F-FDG PET/CT. Nucl Med Commun 2013; 34:50-6. [PMID: 23111376 DOI: 10.1097/mnm.0b013e32835aaa48] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM Secondary central nervous system (CNS) involvement is a devastating and usually fatal complication of non-Hodgkin's lymphoma (NHL). We aimed to evaluate the incidence of secondary CNS involvement and the value of (18)F-FDG PET/computed tomography (CT) imaging in the detection of secondary CNS involvement in patients with NHL. METHODS A total of 123 immunocompetent patients (58 men, 65 women; mean age: 56.5±19.2) with biopsy-proven NHL who underwent (18)F-FDG PET/CT for primary staging (n=68) and restaging (n=55) of recurrent disease were reviewed retrospectively. Those with secondary CNS involvement as diagnosed on PET/CT were identified. CNS involvement was confirmed by MRI and cerebrospinal fluid cytology. RESULTS The clinical Ann Arbor stages of the patient population were as follows: stage I - 10 patients; stage II - 44 patients; stage III - 32 patients, and stage IV - 37 patients. PET/CT detected CNS involvement in six patients. The ages of patients with CNS disease ranged from 23 to 68 (mean: 47.2) years. Three patients presented with CNS involvement associated with systemic disease manifestation at initial diagnosis; one patient had isolated CNS relapse and two had relapsed systemic NHL with progression to CNS involvement. Relapse interval was 8-12 months following initial diagnosis. The types of CNS involvement in patients were as follows: parenchymal (n=2), leptomeningeal (n=2), both parenchymal and leptomeningeal (n=1), and pituitary gland involvement (n=1), which is an uncommon manifestation. Median duration of survival was 2.5 months after the diagnosis of CNS involvement. CONCLUSION The incidence of secondary CNS involvement was 4.4% at initial diagnosis and 5.4% among patients with relapse of lymphoma in our study. PET/CT is a sensitive, objective, and valuable method for the diagnosis of secondary CNS involvement in patients with NHL. In addition, pituitary gland involvement, as a very rare manifestation of secondary CNS lymphoma, has been shown.
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95
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Teachey DT, Hunger SP. Predicting relapse risk in childhood acute lymphoblastic leukaemia. Br J Haematol 2013; 162:606-20. [PMID: 23808872 DOI: 10.1111/bjh.12442] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Intensive multi-agent chemotherapy regimens and the introduction of risk-stratified therapy have substantially improved cure rates for children with acute lymphoblastic leukaemia (ALL). Current risk allocation schemas are imperfect, as some children are classified as lower-risk and treated with less intensive therapy relapse, while others deemed higher-risk are probably over-treated. Most cooperative groups previously used morphological clearance of blasts in blood and marrow during the initial phases of chemotherapy as a primary factor for risk group allocation; however, this has largely been replaced by the detection of minimal residual disease (MRD). Other than age and white blood cell count (WBC) at presentation, many clinical variables previously used for risk group allocation are no longer prognostic, as MRD and the presence of sentinel genetic lesions are more reliable at predicting outcome. Currently, a number of sentinel genetic lesions are used by most cooperative groups for risk stratification; however, in the near future patients will probably be risk-stratified using genomic signatures and clustering algorithms, rather than individual genetic alterations. This review will describe the clinical, biological, and response-based features known to predict relapse risk in childhood ALL, including those currently used and those likely to be used in the near future to risk-stratify therapy.
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Affiliation(s)
- David T Teachey
- Pediatric Hematology and Oncology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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96
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Tavil B, Ayçicek A, Azik F, Tunc B, Del Castello BE, Uçkan D. Efficacy of hematopoietic stem cell transplantation and prophylactic triple intrathecal therapy in a child with multiple CNS relapse of acute lymphoblastic leukemia. Clin Transplant 2013; 27:E346-7. [PMID: 23781848 DOI: 10.1111/ctr.12167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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97
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Aviv A, Tadmor T, Polliack A. Primary diffuse large B-cell lymphoma of the breast: looking at pathogenesis, clinical issues and therapeutic options. Ann Oncol 2013; 24:2236-44. [PMID: 23712546 DOI: 10.1093/annonc/mdt192] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Primary breast lymphoma is a rare form of non-Hodgkin lymphoma with some distinct clinical features. The most common histopathological type is diffuse large B-cell lymphoma (DLBCL), but other less frequent subtypes are also encountered. In this review, we describe the characteristics of primary breast DLBCL, with emphasis on pathogenesis, staging, risk stratification and prognosis. In addition, key issues regarding therapy and various available therapeutic modalities are addressed, as well as the role of rituximab in therapy and whether central nervous system prophylaxis is still routinely required. There are very few prospective clinical studies addressing therapy, and available data rely mostly on retrospective case series involving small numbers of patients. Our conclusions and proposed recommendations are therefore not offered as formal guidelines. This review attempts to represent an unbiased analysis of the published data and is intended as a useful aid for clinicians treating this uncommon type of extra nodal lymphoma.
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Affiliation(s)
- A Aviv
- Hematology Unit, Emek Medical Center, Afula, Israel
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98
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Galati D, Di Noto R, Del Vecchio L. Diagnostic strategies to investigate cerebrospinal fluid involvement in haematological malignancies. Leuk Res 2013; 37:231-7. [PMID: 23287431 DOI: 10.1016/j.leukres.2012.11.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 11/15/2012] [Accepted: 11/26/2012] [Indexed: 12/01/2022]
Abstract
Central nervous system (CNS) involvement is a fatal complication of certain haematological malignancies with an incidence as high as 25% in specific leukaemia/lymphoma subtypes. It is often accompanied by 'occult' cerebrospinal fluid (CSF) involvement at diagnosis, which is frequently missed by conventional cytology examination. Unfortunately, a diagnostic gold standard is yet unavailable since CSF morphology may be negative for malignant cells in up to 45% of patients with suspected meningeal involvement. New technologies such as flow cytometry, molecular genetics and newer biomarkers may improve sensitivity and specificity facilitating the diagnosis of CNS involvement as well as effective prophylaxis and successful treatment.
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Affiliation(s)
- Domenico Galati
- Dipartimento Ematologico, Istituto Nazionale Tumori, IRCCS "Fondazione Pascale", Naples, Italy
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99
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Jorgensen M, Shankar A, Aabideen Z, Cheng D, Goulden N, Vora A, Grandage V, Hough R, Samarasinghe S. The role of routine surveillance for silent central nervous system relapse in children with acute lymphoblastic leukaemia. Br J Haematol 2012; 159:368-70. [PMID: 22924660 DOI: 10.1111/bjh.12021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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100
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Numb chin syndrome with vagal and hypoglossal paralysis: an initial sign of an uncommon diagnosis. Am J Med Sci 2012; 344:241-4. [PMID: 22739563 DOI: 10.1097/maj.0b013e318256050f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In this study, the case of a 58-year-old man with a 2-month history of left chin paresthesia with difficulty swallowing and chewing, and dysphonia is reported. He had an absence of the gag reflex, unilateral palatal palsy and deviation of the tongue upon attempted protrusion with unilateral atrophy. Magnetic resonance imaging of the skull base revealed a tumoral infiltration of the left side of Meckel's cave, involvement of the clivus with extension into the cavernous sinus and signs of focal leptomeningeal infiltration. The patient was eventually diagnosed with generalized Burkitt's lymphoma. In this study, the authors suggest an initial diagnostic workup that includes a computed tomography scan of the mandible and a magnetic resonance imaging of the skull base searching for malignancy in patients with isolated numb chin syndrome, a rare disorder often associated with cancer, especially breast cancer and lymphoma, with mandibular metastases, leptomeningeal seeding and metastases of the base of the skull explaining the origin of the syndrome in most cases.
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