Alakel N, et al. – Experts undertook this work to probe the data of patients treated in three prospective trials of the “Study Alliance Leukemia” (SAL) study group for central nervous system (CNS) involvement. The prevalence of CNS involvement at initial diagnosis in adult patients with acute myeloid leukemia (AML) was low. Data depicted new risk factors. They encouraged to employ intense diagnostic and treatment strategies in patients with risk factors.

Methods

• They examined 3,261 AML patients included in the prospective AML96, AML2003, and AML60+ trials of the SAL study group.
• According to morphology and/or flow cytometry of the CSF, symptomatic patients underwent cerebrospinal fluid (CSF) puncture and CNS involvement were diagnosed.
• In order to identify risk factors, cytogenetic, molecular, clinical, and laboratory parameters were analyzed.

Results

• Results reported symptomatic CNS involvement in 55 patients.
• As compared with first diagnosis (21 patients, 0.6%), significantly more patients revealed CNS involvement at relapse (34 patients, 2.9%), p<0.001.
• In patients with complex aberrant karyotypes, high serum lactate dehydrogenase activity, French–American–British M5 subtype, FLT3–internal tandem duplication (ITD) mutations alone, and co-occurrence of a FLT3–ITD and NPM1 mutation, CNS involvement at initial diagnosis had a significantly higher frequency.
• This study found an inferior outcome in AML patients with CNS involvement at diagnosis compared with patients without CNS involvement even if treated with intrathecal chemotherapy with an overall survival of 11% versus 30% at 5 years, p=0.004.