Staging of acute leukemia and the relationship to CNS involvement.Staging of all and CNS disease

This is the authors' abstract. We don't add key points for this paper.

One hundred eighty-two children with acute lymphoblastic leukemia (ALL), reticulum cell sarcoma (RCS), and lymphocytic lymphosarcoma (LS) were divided into four groups as follows: Group 1—LS or RCS which never undergoes leukemic conversion; Group 2—Gross nodal enlargement either ALL from diagnosis or localized LCS or RCS subsequently converting to ALL; Group 3—ALL with palpable spleen or liver, but no gross nodal enlargement; Group 4—ALL without palpable spleen, liver, or gross nodal enlargement. It was found that Group 4, despite a superior survival (42.5 months), had a reduced incidence (31.8%) of central nervous system leukemia. Leukemic “conversion” of LS or RCS and ALL with gross nodal enlargement (Group 2) had the shortest survival (median 8.5 months) but a relatively high percentage (58.8%) with CNS disease. In non-converting LS or RCS (Group 1) only 20% had CNS involvement. On histologic criteria alone, 14.3% with RCS had CNS disease, whereas 57.9% of those with LS were affected. It is felt that a distinct adverse relationship exists between extra medullary enlargement of spleen, liver, and lymph nodes at diagnosis and the subsequent involvement of the CNS in ALL and transforming LS.