Diagnosis of early subclinical central nervous system involvement with leukemia and lymphoma

ABSTRACT

Several recent studies have identified the increased incidence of central nervous system [CNS] involvement in patients with acute leukemia and malignant lymphoma [Miller et al., 1994]. Even though, increased occurrence of primary CNS disease, in Non-Hodgkin's lymphoma has been reported [OSullivan et al., 1991]. Different diagnostic procedures, have been used for early detection of CNS involvement but uptill now there is an urgent need for easy and clinically applicable methods. In the present study we have assessed the diagnostic value of the determination of cerebrospinal fluid [CSF] carcinoembryonic antigen [CEA], Beta[2] macroglobulin [Beta[2]-MG], beta-glucuronidase[Beta-Glu], lysozyme [Lys], lecithin cholesterol acyl transferase [LCAT] and lactate dehydrogenase [LDH] in detecting early CNS infiltration in patients with acute leukemia and malignant lymphoma and comparing their results wilt. Computerized axial tomography [CAT] for the brain in some of these patients. The study was cross-sectional at Assiut university hospital conducted on 25 cases with acute leukemia and 20 patients with malignant lymphoma. The results of CSF markers were compared with the corresponding values in 20 subjects who underwent lumbar puncture during minor surgical operations for intrathecal anesthesia. The present study revealed significant increment of all the markers studied in sera and CSF of patients with and acute leukemia in comparison with control group Patients with evidences of CNS involvement showed significant elevations of CEA [P<0.01] beta-Glu [P<0.01], Beta[2] MG [P<0.001], lysozyme [P<0.01], LCAT [P<0.01] and LDH [P<0.001] compared with patients without evidences of CNS involvement. Meanwhile, the sensitivity of CSF CEA, Beta-Glu, Beta-G,-MG, lysozyme, LCAT and LDH in diagnosis of patients with CNS involvement was 88 percent, 71 percent, 88 percent, 71 percent, 67 percent and 75% respectively. However, among patients without CNS involvement, 43 percent, 33 percent, 38 percent, 33 percent, 29 percent and 33 percent had elevated CSF levels of the previous markers respectively. These patients could have CNS involvement in the preclinical stage. Based on the present data and stability of the tumor markers studied, markers combination of choice in diagnosing CNS metastasis in patients with acute leukemia and lymphoma may be formed of CEA and Beta Glu. These markers are more easy to be done, of low cost and more applicable than CAT