Association between traumatic lumbar puncture and the risk of central nervous system relapse in adults with acute lymphoblastic leukaemia

Abstract

Intrathecal chemoprophylaxis prevents central nervous system relapses in patients with acute lymphoblastic leukaemia (ALL) but few studies have addressed the predictive markers of relapse. Among these, traumatic lumbar puncture (TLP) has been associated with lower disease-free survival (DFS). To investigate the risk posed by TLP on relapse and DFS, we assembled a retrospective cohort including 79 patients with ALL who received intrathecal chemoprophylaxis during 2009 to 2013. One TLP per patient was recorded in 49 cases, and more than one TLP in 3. Mean follow-up was 283 (22–1118) days with an overall DFS of 68%. DFS was significantly lower in the group that had experienced TLP (58% vs 100% [P = .070]). Multiple TLP posed a greater risk of relapse than single TLP (P = .001). In conclusion, TLP in adults constitutes a major risk factor, greater than that reported in the large paediatric series.

Keywords

• Spinal puncture
• Disease-free survival
• Leukaemia
• Central nervous system
• Recurrence