Cerebrospinal Fluid Analysis of Acute Lymphoblastic Leukaemia Patients Attending at a Tertiary Care Hospital

Abstract

Background: Acute lymphoblastic leukaemia (ALL) is a malignant disease of the bone marrow in which lymphoid precursors undergoes a sequence of somatic mutations leading to excessive proliferation and replaces the normal hematopoietic cells of the bone marrow. CNS involvement with lymphoblast is associated with a very poor prognosis and reduced overall survival. CNS may be   involved at diagnosis or relapse. In this study we used conventional biochemical and cytological analysis of CSF along with Flow cytometry to detect lymphoblast in CSF. Methods: This is an observational study conducted in department of haematology, Dhaka Medical College Hospital (DMCH) from July 2017 to December 2017. Purposive sampling was done. After taking informed written consent properly CSF was taken from lumber puncture for cytology, biochemistry and for flow cytometry. After proper data collection sample was analyse using SPSS 20 for Windows 7 program version. Results: Total 50 patients of ALL were included in this study. Flow cytometry (FCM) of CSF fluid showed 10 patients (20%) have CNS involvement. Median age CNS disease vs without CNS disease were 29 vs 21 years (p>0.05). Among the 50 participants 30 were male and 20 were female. Among the 10 patients with CNS diseases 6 were male and 4 were female. 46 cases were newly diagnosed ALL (92%). Among new cases 6 (13%) had CNS involvement. Among 4 relapsed cases 100% had CNS involvement (p<0.001). Patients with or without CNS involvement had median haemoglobin, WBC, and blasts respectively 7.2g/dl and 7.15g/dl, 21x103/µl and 26 x103/µl, and 65% and 45% (p>0.05). Among patients who had CNS involvement 50% had T cell involvement and another 50 had B cell involvement. The most common translocation was t(12;21) found in 24 (48%) patients. t(9:22) was present in 9 (18%) cases (5 with CNS involvement and 4 without CNS involvement). Conclusion: Although acute lymphoblastic leukaemia is a common malignancy of childhood, but it can also affect adults. This study revealed that median age of the ALL in our country is second decade with slight male preponderance. About one fifth of the patients had CNS involvement with equal sharing of B and T cell origin.