November 15, 2000Blood
Traumatic lumbar puncture at diagnosis adversely affects outcome in childhood acute lymphoblastic leukemia
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Discussion
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Implication
Retrospective cohort study reveals reduced event-free survival after traumatic lumbar puncture in childhood leukemia, indicating a need for intensified intrathecal therapy.
Key Points
- To determine whether introducing leukemic blast cells into cerebrospinal fluid via traumatic lumbar puncture during initial diagnosis impairs treatment outcomes in pediatric acute lymphoblastic leukemia.
- Retrospective review of 546 pediatric patients with newly diagnosed acute lymphoblastic leukemia enrolled in two consecutive front-line trials (1984–1991) at St Jude Children's Research Hospital.
- Evaluated blast cell contamination in the first two lumbar punctures, performed at initial diagnostic workup and at first intrathecal chemotherapy administration.
- Patients with one contaminated cerebrospinal fluid sample had significantly worse event-free survival than those with no contamination (P = 0.026).
- Patients with two consecutive contaminated samples experienced poor outcomes (5-year event-free survival = 46 ± 9%), which remained the strongest prognostic indicator in multivariable analysis (HR 2.39; 95% CI, 1.36–4.20).
Cite This Study
Gajjar et al. (2000) studied this question.