Central Nervous System Disease Relapse Low in Patients with Acute Lymphocytic Leukemia

Patients who do not receive prophylaxis against central nervous system (CNS) disease during treatment for acute lymphocytic leukemia (ALL) have an increased risk of recurrence. However, a study observed a low rate of CNS relapse in patients with ALL. The results of the single-center study were presented by Pamiz Alibhai, PharmD, MBA, a post-graduate year 2 hematology/oncology resident at the University of Alabama at Birmingham Medicine, at HOPA’s 16th Annual Conference.

Adult patients (n=90; median age at diagnosis, 46 years) who were newly diagnosed with ALL between July 31, 2013, and July 31, 2019, were retrospectively identified for the study. Researchers collected information on demographics, disease characteristics, treatment regimens, and outcomes. Patients were characterized as low (n=29) or high (n=61) risk of CNS relapse.

More than one-third of patients (n=37; 41%) had Philadelphia chromosome-positive disease, and most patients (n=78; 87%) had precursor B-cell ALL. Median baseline white blood cell count was 7.1/mcL and lactate dehydrogenase was 628 units/L.

Two patients presented with CNS disease at baseline. More than half of patients (n=50; 55%) received a hyper-CVAD (cyclophosphamide, vincristine, doxorubicin, dexamethasone) regimen.

Five patients in the high-risk group had CNS relapse. These patients received a median of six intrathecal treatments (range, 2-7 treatments). Factors associated with high CNS risk were mature B-cell type, T-cell type, white blood cell count >30,000 mL, or lactate dehydrogenase >600 units/L.

“[The] rate of CNS relapse at our center was in the lower range of that reported in other studies (4% to 11%),” the authors noted. “Further studies are needed to evaluate the ideal number of treatments needed for patients who are at high or low risk of CNS relapse.”

Alibhai P, Ye S, Herbert C, et al. Evaluating rates of CNS relapse in newly diagnosed adult patients with acute lymphoblastic leukemia at an academic medical center. Presented at HOPA 16th Annual Conference. March 2020, Tampa, Florida.