Central Nervous System Relapse in Acute Lymphoblastic Leukemia (Study on 160 Cases)

From 1365 to 1382, 205 cases of acute lymphoblastic leukemia (all) were refered to our center. 160 cases achived complete remission and entered our clinical trial of cns relapse which were under consideration. the patients included 98 men and 62 women with an average age of 32 years (range 4-61 years). 160 of 205 cases had complete remission with a rate about 78%.the latter group was entered into our clinical trial. the patients were followed for 30 months after starting maintenance therapy. all patients underwent cns prophelaxy by cns irradiation with 14 gy and intratechal methotrexate in jection for 6 weeks. 24 cases had relapsed. the age of cns relapsed patients were between 9 to 58 years (mean 31y). patient sex: 11 male of 91, 13 female of 69.
results: 1 case showed cns relapse after 4 months of starting maitenance therapy. 19 cases relapsed in the duration of 6-18 months after starting maintenance therapy. 2 cases relapsed within 24 & 28 months after starting maintenance therapy. the statistic analysis are summarized as follows: 1-cns relapse of allin the females are more than males (p=0.001). 2-cns relapse of all in the age groupe older than 12 years were higher.
3-cns relapse of all in those patients with bone marrow failure in responding to first period of treatment were higher (p=0.002).
4-cns relapse of all in those patients with leukocytosis more than 40.000/ul were higher (p=0.003). 5-the first symptom of cns relapse was severe headache (100%). 6-cns relapse of all were in 18 months period of strating maintenance therapy. 7-cns relapse of all in those patients with type ii all were more than type i, with a rate of 18.7 % and 4.7% respectively.