High sensitivity of flow cytometry improves detection of occult leptomeningeal disease in acute lymphoblastic leukemia and lymphoblastic lymphoma

• DOI: 10.1007/s00277-014-2080-6
• Publication Date: 2014-04-21T16:37:29Z
• Authors: Maria Ilaria Del ...; Francesco Buccisano; Mariagiovanna Cefalo; Luca Maurillo; Luigi Di Caprio; Fabio Di Piazza; Chiara Sarlo; Gottardo De Angelis; Maria Irno Consalvo; Daniela Fraboni; Giovanna De Santis; Concetta Ditto; Massimiliano Post...; Giuseppe Sconocchia; Giovanni Del Poeta; Sergio Amadori; Adriano Venditti
• Keywords: Conventional cytology; Adult; Male; Adolescent; Cytodiagnosis; Leptomeningeal disease; Acute lymphoblastic leukemia; Sensitivity and Specificity; Young Adult; 03 medical and health sciences; Meninges; 0302 clinical medicine; Lymphoblastic lymphoma; Leukemic Infiltration; Meningeal Neoplasms; Humans; Flow cytometry; Aged; Middle Aged; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Flow Cytometry; 3. Good health; Settore MED/15 - MALATTIE DEL SANGUE; Cerebrospinal fluid; Female

Conventional cytology (CC) of cerebrospinal fluid (CSF) fails to demonstrate malignant cells in up to 45 % of patients with acute lymphoblastic leukemia or lymphoblastic lymphoma (ALL/LL) in whom occult leptomeningeal disease is present. Flow cytometry (FCM) is considered more sensitive than CC, but clinical implications of CC negativity/CC positivity are not yet established. CSF samples from 38 adult patients with newly diagnosed ALL/LL were examined. Five (13 %) and nine (24 %) specimens were CC positive-FC positive (FCM(pos)/CC(pos)) and CC negative-FC positive (CC(neg)/FCM(pos)), respectively. The remaining 24 (63 %) samples were double negative (CC(neg)/FCM(neg)) (p = 0.001). CC(neg)/FCM(pos) patients showed a significantly shorter overall survival (OS) compared to CC(neg)/FCM(neg) ones. In multivariate analysis, the status of single FCM positivity was demonstrated to affect independently duration of OS (p = 0.005). In conclusion, FCM significantly improves detection of leptomeningeal occult localization in ALL/LL and appears to anticipate an adverse outcome. Further prospective studies on larger series are needed to confirm this preliminary observation.