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Effects of isolated central nervous system involvement evaluated by multiparameter flow cytometry prior to allografting on outcomes of patients with acute lymphoblastic leukemia. | LitMetric

AI Article Synopsis

  • Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a key treatment for acute lymphoblastic leukemia (ALL), and this study examined the significance of isolated flow cytometry-positive central nervous system (CNS) involvement before the transplant.
  • Among 1406 ALL patients, those with isolated FCM-positive CNS involvement had significantly higher rates of relapse and lower leukemia-free survival compared to those with negative CNS involvement.
  • The study developed a scoring system to categorize patients into risk groups based on pre-HSCT factors, highlighting that patients with isolated CNS involvement face a greater risk of recurrence following transplantation.

Article Abstract

Introduction: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a major strategy to cure patients with acute lymphoblastic leukemia (ALL). The aim of this study was to evaluate whether isolated flow cytometry (FCM)-positive central nervous system (CNS) involvement before allo-HSCT is clinically significant.

Methods: The effects of isolated FCM-positive CNS involvement prior to transplantation on the outcomes of 1406 ALL patients with complete remission (CR) were retrospectively investigated.

Results: Patients were classified into isolated FCM-positive CNS involvement (n=31), cytology-positive CNS involvement (n = 43), and negative CNS involvement (n = 1332) groups. Among the three groups, the 5-year cumulative incidence of relapse (CIR) values were 42.3%, 48.8%, and 23.4%, respectively (<0.001). The 5-year leukemia-free survival (LFS) values were 44.7%, 34.9%, and 60.8%, respectively (<0.001). Compared with the negative CNS group (n=1332), the 5-year CIR of the pre-HSCT CNS involvement group (n=74) was higher (46.3% . 23.4%, <0.001], and the 5-year LFS was inferior (39.1% . 60.8%, <0.001). Multivariate analysis indicated that four variables, T-cell ALL, in second complete remission or beyond (CR2+) at HSCT, pre-HSCT measurable residual disease positivity, and pre-HSCT CNS involvement, were independently associated with a higher CIR and inferior LFS. A new scoring system was developed using the following four variables: low-risk, intermediate-risk, high-risk, and extremely high-risk groups. The 5-year CIR values were 16.9%, 27.8%, 50.9%, and 66.7%, respectively (<0.001), while the 5-year LFS values were 67.6%, 56.9%, 31.0%, and 13.3%, respectively (<0.001).

Conclusion: Our results suggest that ALL patients with isolated FCM-positive CNS involvement are at a higher risk of recurrence after transplantation. Patients with pre-HSCT CNS involvement had higher CIR and inferior survival outcomes.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10209422PMC
http://dx.doi.org/10.3389/fonc.2023.1166990DOI Listing

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