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A Practical Strategy of Monitoring Minimal Residue Disease and Intervention for Central Nervous System Relapse of Childhood Acute Lymphoblastic Leukemia: A Single Chinese Center’s Experience

Liang, Yang MD, PhD*; Ca, Qing MD*,†; Zhai, Zhi-Min MD, PhD; Wang, Ning-Ling MD§

Journal of Pediatric Hematology/Oncology: July 2013 - Volume 35 - Issue 5 - p 388–393
doi: 10.1097/MPH.0b013e31829084eb
Clinical and Laboratory Observations

Objective: To investigate monitoring minimal residual disease (MRD) using cerebral spinal fluid for predicting central nervous system leukemia (CNSL) and treatment.

Observations: There is no survival difference between enhanced triple intrathecal therapy (ETIT) and cranial radiation for CNSL patients with positive morphology and MRD. Positive MRD correlated with CNSL, whereas negative MRD indicated a lower chance of CNSL recurrence. Altogether 79 cerebral spinal fluid specimens indicating negative morphology but positive MRD were given either ETIT or conventional triple intrathecal therapy. The ETIT group indicated lower relapse.

Conclusion: Flow cytometry is sensitive to predict CNSL and ETIT is a potent intervention.

*Section of Hematology, Yale Cancer Center, Yale University Medical School, New Haven, CT

Departments of §Pediatrics

Hematology, The Second Affiliated Hospital of Anhui Medical College, Hefei

Department of Hematology, The Second People’s Hospital of Chizhou, Chizhou, China

N-L.W. and Y.L. contributed equally.

N-L.W., and Y.L.—designed research; N-L.W., Q.C., and Z-M.Z.—performed research; N-L.W., Q.C., and Z-M.Z.—collected data; N-L.W., and Y.L.—analyzed data and wrote the paper.

The authors declare no conflict of interest.

Reprints: Ning-Ling Wang, MD, Department of Pediatrics, the Second Affiliated Hospital of Anhui Medical College, 678 Furong Road, Hefei 230031, Anhui Province, China (e-mail:

Received August 2, 2011

Accepted February 20, 2013

© 2013 by Lippincott Williams & Wilkins.