Leukemic blasts are present at low levels in spinal fluid in one-third of childhood acute lymphoblastic leukemia cases

Research output: Contribution to journalArticle


Background: Central nervous system (CNS) involvement is associated with relapse in childhood acute lymphoblastic leukemia (ALL) and is a diagnostic challenge. Procedure: In a Nordic/Baltic prospective study, we assessed centralized flow cytometry (FCM) of locally fixed cerebrospinal fluid (CSF) samples versus local conventional cytospin-based cytology (CC) for detecting leukemic cells and evaluating kinetics of elimination of leukemic cells in CSF. Results: Among 300 patients with newly diagnosed ALL, 87 (29%) had CSF involvement by FCM, while CC was positive in 30 (10%) of 299 patients with available CC data (P < 0.001). Patients with FCM+/CC+ had higher CSF leukemic blast counts compared to patients positive by FCM only (medians: 0.10 vs. 0.017 leukemic blasts/μl, P = 0.006). Patients positive by FCM had higher white blood cell counts in peripheral blood than patients negative by FCM (medians: 45 × 109/l vs. 10 × 109/l, P < 0.001), were younger (medians: 3 years vs. 4 years, P = 0.03), and more frequently had T-cell ALL (18/87 vs. 16/213, P = 0.001). At treatment day 15, five of 52 patients (10%) who had CSF positive by FCM at diagnosis remained so despite at least two doses of weekly intrathecal chemotherapy. Conclusions: Longer follow-up is needed to clarify whether FCM positivity has prognostic significance and is an indicator for intensified CNS-directed therapy.


  • Mette Levinsen
  • Hanne V. Marquart
  • Line Groth-Pedersen
  • Jonas Abrahamsson
  • Birgitte K. Albertsen
  • Mette K. Andersen
  • Thomas L. Frandsen
  • Arja Harila-Saari
  • Cornelis Pronk
  • Aina Ulvmoen
  • Goda Vaitkevičienė
  • Päivi M. Lähteenmäki
  • Riitta Niinimäki
  • Mervi Taskinen
  • Maria Jeppesen
  • Kjeld Schmiegelow
External organisations
  • Copenhagen University Hospital
  • Sahlgrenska University Hospital
  • Aarhus University Hospital
  • Karolinska University Hospital
  • Skåne University Hospital
  • Turku University Hospital
  • Oulu University Hospital
  • Oslo university hospital
  • Vilnius University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Hematology


  • acute, ALL, CSF leukemia, leukemias, minimal residual disease
Original languageEnglish
Pages (from-to)1935-1942
Number of pages8
JournalPediatric Blood & Cancer
Issue number11
Publication statusPublished - 2016 Nov 1
Publication categoryResearch