Multi-institutional analysis of outcomes in acute myeloid leukemia patients with central nervous system involvement

Abstract

We evaluated outcomes of AML patients with central nervous system (CNS) involvement at two academic institutions. Fifty-two adult patients were identified. Neurologic symptoms were reported in 69% of patients, with headache the most common (33%). 84% (n = 42) of patients cleared their cerebrospinal fluid (CSF), with a median number of one dose of intrathecal (IT) chemotherapy. Of these patients, 21% (n = 9) had a CSF relapse, with 67% (n = 6) of those experiencing CSF relapse also having concurrent bone marrow relapse. Of the 36 patients with baseline neurologic symptoms, 69% had improvement in symptoms post-IT therapy. The median overall survival was 9.3 months and 3.5 months for patients with CNS involvement diagnosed before/during induction and at relapse, respectively. In this study, IT therapy was rapidly effective in clearing CSF blasts and improving neurologic symptoms in most patients. Few patients experienced CSF relapse, which predominantly occurred in the setting of concomitant bone marrow relapse.

Keywords:

• Acute myeloid leukemia
• central nervous symptoms
• intrathecal chemotherapy
• neurologic symptoms
• extramedullary

Disclosure statement

JF has received consulting fees from Gilead. MK has received consulting fees Protagonist, Incyte, Morphosys, Abbvie. JM has received research funding paid to the institution from Novartis, CTI, Incyte, BMS, Abbvie, Kartos and PharmaEssentia and consulting fees from Incyte, CTI Bio, Novartis, Roche, GSK, Sierra Onc, PharmaEssentia, Kartos, Karyopharm, Galecto, Imago, BMS, Abbvie and Geron. HM has received research funding from Jazz Pharmaceuticals, Chimerix and Takeda pharmaceuticals. TL has received research funding paid to her institution from Bio-Path Holdings, Astellas Pharma, Celyad, Aptevo Therapeutics, Cleave Biosciences, CicloMed, and Jazz Pharmaceutrics. DT has received research funding paid to his institution from CTI Biopharma, Astellas Pharma and Gilead and consulting fees from CTI Biopharma, Novartis, AbbVie, Sierra Oncology, GSK and Cogent. The other authors have no conflicts of interests to report.

Data availability Statement

All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

No support for this work was received in the form of funding or grants