急性髓性白血病成年患者无症状中枢神经系统受累的发生率、风险因素和结果

IF 3.3 4区 医学 Q2 HEMATOLOGY
Marijana Virijevic, Nada Kraguljac-Kurtovic, Mirjana Mitrovic, Ljubomir Jakovic, Zoran Bukumuric, Nikola Pantic, Nikica Sabljic, Zlatko Pravdic, Mirjana Cvetkovic, Vesna Knezevic, Tijana Dragovic-Ivancevic, Irena Djunić, Jovan Rajic, Violeta Milosevic, Milena Todorovic-Balint, Ana Vidovic, Nada Suvajdzic-Vukovic
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引用次数: 0

摘要

中枢神经系统(CNS)受累检查并非急性髓性白血病(AML)成人患者的常规诊断方法。因此,许多中枢神经系统受累的无症状患者可能未被发现。中枢神经系统受累对急性髓性白血病病程的影响尚未明确,临床结果也不尽相同。本研究旨在确定诊断时通过脑脊液多参数流式细胞术(MFC-CSF)估计的无症状中枢神经系统受累的发生率、相关潜在风险因素和预后。共筛查了645名新发急性髓细胞白血病患者,其中183人(28.4%)符合根据中枢神经系统症状和/或临床特征进行MFC-CSF分析的机构惯例。8/183(4.4%)例患者出现中枢神经系统症状和体征,但大多数患者(175/183,95.6%)无症状。在无症状组中,73/175(41.7%)名患者的脑脊液(CSF)检查结果呈阳性或可疑,被归类为中枢神经系统阳性(CNSpos),102/175(58.3%)名患者的中枢神经系统检查结果正常,被归类为中枢神经系统阴性(CNSneg)。81/183(44.3%)例患者确诊存在白血病胚泡;整个急性髓细胞白血病组的中枢神经系统受累总发生率为 12.6%(81/645)。与无症状的 CNSneg 患者相比,CNSpos 患者出现淋巴结肿大、白细胞计数≥30 × 109/L、单核细胞表型和骨髓(BM)囊泡比例高的频率明显更高。多变量逻辑回归模型确定单核细胞表型(p = 0.047)和高比例的骨髓细胞凋亡(p = 0.042)是 CNSpos 的预测因素。CNSpos并不影响急性髓细胞白血病患者的总生存率。无症状的新发急性髓细胞性白血病成年患者中枢神经系统受累的发生率较高,这强调了诊断时中枢神经系统疾病的发生率可能被低估。前瞻性研究应确定诊断性腰椎穿刺进行MFC-CSF分析和中枢神经系统预防性治疗是否有助于改善这类患者的选择和预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Incidence, risk factors, and outcome of asymptomatic central nervous system involvement in adult patients with acute myeloid leukemia

Examination of central nervous system (CNS) involvement is not routine diagnostic practice in adult patients with acute myeloid leukemia (AML). Therefore, many asymptomatic patients with CNS involvement might go undetected. The effect of CNS involvement on the AML disease course is not well defined, with conflicting results regarding clinical outcome. This study aimed to determine the incidence of asymptomatic CNS involvement in AML estimated by multiparametric flow cytometry of cerebrospinal fluid (MFC-CSF) at diagnosis, the related potential risk factors, and prognosis. In total, 645 patients with de novo AML were screened; 183 (28.4%) of them fulfilled institutional practice for MFC-CSF analysis based on presence of CNS symptoms and/or clinical features. CNS symptoms and signs were observed in 8/183 (4.4%) patients, but most patients (175/183, 95.6%) were asymptomatic. In the asymptomatic group, 73/175 (41.7%) patients had positive or suspicious cerebrospinal fluid (CSF) findings categorized as CNS positive (CNSpos) and 102/175 (58.3%) had normal CNS findings categorized as CNS negative (CNSneg). The presence of leukemic blasts was confirmed in 81/183 (44.3%) patients; the total incidence of CNS involvement in the whole AML group was 12.6% (81/645). Compared with asymptomatic patients with CNSneg, those with CNSpos had a significantly higher frequency of lymphadenopathy, white blood cell count ≥30 × 109/L, presence of the monocytic phenotype, and a high percentage of bone marrow (BM) blasts. The multivariate logistic regression model identified monocytic phenotype (p = 0.047) and high percentage of BM blasts (p = 0.042) as predictors for CNSpos. CNSpos did not affect overall survival in patients with AML. There was a higher incidence of CNS involvement in asymptomatic adult patients with de novo AML, emphasizing possible undervalued rates of CNS disease at diagnosis. Prospective studies should determine whether diagnostic lumbar puncture for MFC-CSF analysis and CNS prophylaxis could contribute to better selection and prognosis in this patient population.

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来源期刊
Hematological Oncology
Hematological Oncology 医学-血液学
CiteScore
4.20
自引率
6.10%
发文量
147
审稿时长
>12 weeks
期刊介绍: Hematological Oncology considers for publication articles dealing with experimental and clinical aspects of neoplastic diseases of the hemopoietic and lymphoid systems and relevant related matters. Translational studies applying basic science to clinical issues are particularly welcomed. Manuscripts dealing with the following areas are encouraged: -Clinical practice and management of hematological neoplasia, including: acute and chronic leukemias, malignant lymphomas, myeloproliferative disorders -Diagnostic investigations, including imaging and laboratory assays -Epidemiology, pathology and pathobiology of hematological neoplasia of hematological diseases -Therapeutic issues including Phase 1, 2 or 3 trials as well as allogeneic and autologous stem cell transplantation studies -Aspects of the cell biology, molecular biology, molecular genetics and cytogenetics of normal or diseased hematopoeisis and lymphopoiesis, including stem cells and cytokines and other regulatory systems. Concise, topical review material is welcomed, especially if it makes new concepts and ideas accessible to a wider community. Proposals for review material may be discussed with the Editor-in-Chief. Collections of case material and case reports will be considered only if they have broader scientific or clinical relevance.
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