What is the role of lumbar puncture and CSF analysis in the workup of pediatric acute myelocytic leukemia (AML)?

Updated: Sep 12, 2017
  • Author: Mark E Weinblatt, MD; Chief Editor: Jennifer Reikes Willert, MD  more...
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Answer

Lumbar puncture is necessary for diagnostic and therapeutic reasons.

Even if the marrow is not involved at the time of diagnosis, CNS seeding can occur later. Therefore, periodic surveillance lumbar puncture with the administration of intrathecal chemotherapy is necessary.

Although the cerebrospinal fluid (CSF) is less frequently involved in acute myeloid leukemia than in ALL, leukemic infiltration has been reported in 5-20% of patients with acute myeloid leukemia, depending on the study. The greatest risk is seen in patients with monocytic subtypes, in infants, and in children with hyperleukocytosis on presentation.

CSF samples should be obtained before any therapy is begun. Fluid should be sent for cytologic evaluation in addition to the usual cell counts and chemical tests.

Intrathecal chemotherapy is administered simultaneously and repeated intermittently to treat or prevent CNS involvement.


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