Incidence of leptomeningitis in acute leukemia
Introduction/Background/Significance: Across all cancer diagnoses, leptomeningeal involvement is seen in roughly 5% of patients and carries a poor prognosis with median survival under 3 months characterized by rapid neurologic decline (1,2).
Materials and Methods/Case Presentation/Objective: At a cancer hospital, in a retrospective study, a total of 1000 reports of CSF cytology were evaluated for the presence of malignant cells. Repeated and hemolyzed samples were excluded from the study. Sediment of centrifuged CSF samples was smeared on a glass slide and stained with MGG stain.
Results/Description/Main Outcome Measures: Out of 1000 cases, 67 (6.7%) cases were positive for malignant cells, with males 48 and females 19. Ages ranged from 1 to 66 years. We found hematolymphoid malignancies (HLM) 54/67 (80.59%), retinoblastoma 7/67 (10.4%), solid tumors 4/67 (5.9%—2 lung cancer, one case of ovary and breast each), and 2 cases of brain tumor (medulloblastoma). Among HLM, we found B-ALL 30/54 (55.5%), T-ALL 11/54 (20.4%), CML 5/54 (9.25%), AML 3/54 (5.54%), lymphoma 3/54 (5.54%, 2 t-ALL & 1 B-ALL), and dendritic cell neoplasm in one case.
Conclusions: Vandana et al. (2017) have shown 60% cases of HLM and 40% cases of solid tumors. These figures in this study are 80% and 20%, respectively. Acute lymphoid leukemia constituted 50% of leptomeningitis, while myeloid one constituted 10%. CNS leukemia is a leading cause of deaths. Blasts stimulate angiogenesis, adhere to CD56, and enter into the CNS through the blood vessels. Early diagnosis through CSF exam, MRI, and flow cytometry is suggested. The role of prophylaxis and early treatment is warranted. Targeted chemotherapy or radiation therapy (to CNS) is advised (3).
References
1. Nolan CP, Abrey LE. Leptomeningeal metastases from leukemias and lymphomas. Cancer Treat Res. 2005;125:53–69. 2. Clarke JL, Perez HR, Jacks LM, Panageas KS, DeAngelis LM. Leptomeningeal metastases in the MRI era(Podcast)(CME). Neurology [Internet]. 2010 May 4 [cited 2023 Feb 19];74(18):1449–54. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2871005/ 3. Deak D, Gorcea-Andronic N, Sas V, Teodorescu P, Constantinescu C, Iluta S, et al. A narrative review of central nervous system involvement in acute leukemias. Ann Transl Med. 2021 Jan;9(1):68.
