Starting chemotherapy several days before the first lumbar puncture for diagnosis and treatment of acute lymphoblastic leukemia (ALL) may reduce the risk of central nervous system (CNS) relapse in children, according to a study published by Tang et al in the journal Blood.
The research focused on how clinical care, including availability of total intravenous anesthesia and the diagnostic tool flow cytometry, may influence the risk of CNS relapse.
“This study identified factors to help us predict and better manage the risk of CNS relapse that will be useful for treating patients with ALL worldwide, in both resource-rich and resource-limited countries,” said corresponding author Ching-Hon Pui, MD, Chair of the St. Jude Department of Oncology.
Identification of Factors
The analysis included 7,640 children and adolescents enrolled in a clinical trial conducted at 20 hospitals and medical centers in China.
The treatment protocol was adapted from recent St. Jude clinical trials. Patients were treated in settings that were widely different in available technology and clinical resources. For example, just 3 of the 20 medical centers offered total intravenous anesthesia for children undergoing spinal taps, and only 2 had flow cytometry to diagnose leukemia cells in cerebrospinal fluid.
The 5-year overall survival rate was 91% for study patients, and the cancer-free survival rate was 80%—a dramatic improvement from previous clinical trials in China. But 1.9% of patients relapsed in the CNS alone, and in another 2.7% of patients, the relapse included the CNS.
Increasing the number of pediatric ALL patients worldwide who become long-term survivors requires identifying those at risk for CNS relapse and preventing it, along with improving their quality of life, explained Dr. Pui.
The identified factors associated with CNS included:
The study authors concluded, “Prephase dexamethasone treatment, delayed intrathecal therapy, use of total intravenous anesthesia during intrathecal therapy, and flow cytometry examination of diagnostic cerebrospinal fluid may improve CNS control in childhood ALL.”
Disclosure: The research was funded in part by VIVA China Children’s Cancer Foundation, National Cancer Institute, St. Baldrick’s Foundation, and ALSAC. For full disclosures of the study authors, visit ashpublications.org/blood.The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.