Abstract 2576

Cerebrospinal fluid (CSF) involvement by leukemic blasts occurs in fewer than 10 % of adult patients with newly diagnosed acute lymphoblastic leukemia/lymphoma (ALL). Leukemic meningitis is diagnosed by microscopic detection of blasts in the CSF. Flow cytometry is a highly sensitive tool for detection of aberrant cells. We sought to analyze the additional benefit flow cytometry might provide for the diagnosis of leukemic meningitis. Between 11/2007 and 8/2011, 80 patients were diagnosed with ALL and treated at Emory University. 800 CSF samples were available for analysis 80 of which were collected from a diagnostic lumbar puncture (LP), 689 from follow-up LPs and 31 from LPs obtained at the time of relapse. As shown in the table, flow cytometry confirmed the presence of leukemic blasts in one, four and five samples diagnosed with leukemic meningitis by cytology at diagnosis, different stages of treatment and relapse, respectively. One and three samples were positive for leukemic blasts by cytology but negative by flow cytometry during different treatment stages and relapse respectively. We conclude that flow cytometry provided no additional benefit to cytology in the diagnosis of leukemic meningitis.

Table:

CSF Cytology and Flow Cytometry in 80 Adult ALL patients:

CSF samples
New Diagnosis N=80Induction/Consolidation/Intensification/Maintenance/Remission/Post-transplant N = 689Systemic relapse N = 31
NCytology N = 80Flow cytometry N = 66Cytology N = 689Flow cytometry N = 188Cytology N = 31Flow cytometry N = 13
Negative 79/80 65/66 684/689 184/188 23/31 8/13 
Positive 1/80 1/66∼ 5/689 4/188∼* 8/31 5/13∼** 
CSF samples
New Diagnosis N=80Induction/Consolidation/Intensification/Maintenance/Remission/Post-transplant N = 689Systemic relapse N = 31
NCytology N = 80Flow cytometry N = 66Cytology N = 689Flow cytometry N = 188Cytology N = 31Flow cytometry N = 13
Negative 79/80 65/66 684/689 184/188 23/31 8/13 
Positive 1/80 1/66∼ 5/689 4/188∼* 8/31 5/13∼** 
∼

CSF samples positive by flow cytometry were also positive by cytology

*

One CSF sample was positive by cytology but negative by flow cytometry

**

CSF flow cytometry was not done in 3/8 positive CSF samples by cytology

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Disclosures:

No relevant conflicts of interest to declare.

Topics:
acute lymphocytic leukemia, cerebrospinal fluid, flow cytometry, lymphoma, carcinomatous meningitis, lipopolysaccharides, van der woude syndrome, diagnostic spinal puncture, disease remission, follow-up

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Author notes

*

Asterisk with author names denotes non-ASH members.

© 2012 by The American Society of Hematology
2012
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