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Multicenter Study
. 2022 Aug 25;39(3):152-159.
doi: 10.4274/tjh.galenos.2022.2021.0680. Epub 2022 Apr 21.

Prophylactic Central Nervous System Irradiation Is Not Indispensable in Adult Patients with Acute Lymphoblastic Leukemia: A Multicenter Retrospective Cohort Study

Olgu Erkin Çınar  1 , Hakan Göker  1 , Kemal Fidan  2 , Öznur Aydın  3 , Tural Pashayev  4 , Ümit Yavuz Malkan  1 , Mustafa Velet  1 , Yahya Büyükaşık  1 , Salih Aksu  1 , Osman İlhami Özcebe  1 , İbrahim Celalettin Haznedaroğlu  1 , Nilgün Sayınalp  1 , Filiz Vural  4 , Mehmet Turgut  3 , Ali Ünal  2 , Haluk Demiroğlu  1
Affiliations
Multicenter Study

Prophylactic Central Nervous System Irradiation Is Not Indispensable in Adult Patients with Acute Lymphoblastic Leukemia: A Multicenter Retrospective Cohort Study

Olgu Erkin Çınar et al. Turk J Haematol. .

Abstract
in English, Turkish

Objective: Studies comparing the efficacy and safety of prophylactic regimens for central nervous system (CNS) involvement in acute lymphoblastic leukemia (ALL) are scarce in adults. This multicenter retrospective study aimed to compare the efficacy of prophylactic regimens with and without CNS irradiation on the development of CNS relapse during follow-up.

Materials and methods: This was a multicenter comparative cohort study. A total of 203 patients were included from four tertiary care centers in Turkey. Patients were divided into two groups according to whether they received CNS irradiation or not. The groups were analyzed retrospectively regarding patient and disease characteristics, with the main focus being CNS relapse.

Results: While 105 patients received chemotherapy-based prophylaxis, 98 patients received additional CNS irradiation. These groups were statistically comparable in terms of demographic characteristics and risk factors for CNS involvement. In the irradiation group, patients were younger and had more stem cell transplants. In a median of 23.8 (11.1-62.4) months, there was no difference between the two groups regarding CNS relapse-free survival (log-rank p=0.787).

Conclusion: Craniospinal irradiation may not be indispensable for every adult patient with ALL, similarly to pediatric patients. It is crucial to avoid the long-term toxicities of radiation, especially in patients with long life expectancy. Craniospinal irradiation may be reserved for therapeutic use in cases of CNS relapse and prophylaxis for some high-risk patients.

Amaç: Erişkin akut lenfoblastik lösemi (ALL) hastalarında, santral sinir sistemi (SSS) tutulumuna karşı kullanılan profilaktik rejimlerin etkinlik ve güvenliğini karşılaştıran çalışma bulunmamaktadır. Bu çok merkezli retrospektif çalışmada, profilakside SSS ışınlamayı içeren ve içermeyen rejimlerin etkinliklerinin karşılaştırılması amaçlanmıştır.

Gereç ve yöntemler: Bu çalışma, karşılaştırmalı retrospektif kohort çalışması olup; Türkiye’de dört farklı üçüncü basamak merkeze başvuran 203 hastayla yapılmıştır. Hastalar, SSS ışınlaması alanlar ve almayanlar olarak iki gruba ayrılmıştır. Gruplar, takipte SSS tutulumu gelişimi temelinde hastaların ve ALL’nin özelliklerine göre karşılaştırılmıştır.

Bulgular: Yüz beş hasta sadece kemoterapi bazlı profilaksi alırken, 98 hasta ek olarak SSS ışınlaması almıştır. SSS ışınlama grubundaki hastaların medyan yaşı daha küçüktür ve kök hücre nakli oranı daha yüksektir. Bunlar haricinde gruplar, demografik özellikler ve SSS tutulumu risk faktörleri açısından benzer dağılım göstermektedir. Medyan 23,8 (11,1-62,4) aylık takipte, SSS tutulumsuz sağkalım açısından iki grup arasında fark saptanmamıştır (log-rank p=0,787).

Sonuç: Pediatrik hastalarda kanıtlandığı gibi erişkin ALL hastalarında da SSS ışınlaması, çok yüksek riskli hastalar dışında profilakside yer almayabilir. Özellikle yüksek yaşam süresi beklenen hastalarda, ışınlamanın nörolojik toksisitesinden kaçınılması da günümüzde amaçlar arasında olmalıdır. Işınlamanın, SSS tutulumu gelişmiş hastalarda terapötik amaçla sınırlandırılması, çok yüksek riskli hastalar dışında iyi bir risk/fayda oranına sahiptir.

Keywords: Craniospinal; Young adults; Radiation toxicity; Centralnervous system relapse; Acute lymphoblastic leukemia.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
Flow chart of the study
Figure 2
Figure 2
The Kaplan-Meier curves of CLFS for all patients (top) and subgroups (non-HSCT, bottom left; HSCT, bottom right) according to the CNS prophylaxis they received. CLFS: Central leukemia-free survival, HSCT: hematopoietic stem cell transplantation.
See this image and copyright information in PMC

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