Association between traumatic lumbar puncture and the risk of central nervous system relapse in adults with acute lymphoblastic leukaemia

Intrathecal chemoprophylaxis prevents central nervous system relapses in patients with acute lymphoblastic leukaemia (ALL) but few studies have addressed the predictive markers of relapse. Among these, traumatic lumbar puncture (TLP) has been associated with lower disease-free survival (DFS).To investigate the risk posed by TLP on relapse and DFS, we assembled a retrospective cohort including 79 patients with ALL who received intrathecal chemoprophylaxis during 2009 to 2013. One TLP per patient was recorded in 49 cases, and more than one TLP in 3. Mean follow-up was 283 (22–1118) days with an overall DFS of 68%. DFS was significantly lower in the group that had experienced TLP (58% vs 100% [P = .070]). Multiple TLP posed a greater risk of relapse than single TLP (P = .001). In conclusion, TLP in adults constitutes a major risk factor, greater than that reported in the large paediatric series.

ResumenLa quimioprofilaxis intratecal evita la recaída a sistema nervioso central en pacientes con leucemia linfoblástica aguda (LAL), aunque poco se ha estudiado sobre marcadores predictivos de recaída. Entre estos, la punción lumbar traumática (TLP) se ha asociado con una menor supervivencia libre de la enfermedad (EFS).Para investigar el riesgo que infiere la TLP sobre la recaída y la EFS, se formó una cohorte retrospectiva compuesta por 79 pacientes con LAL que recibieron quimioprofilaxis intratecal durante 2009 a 2013. Se registró una TLP por paciente en 49 casos y más de una en 3. La media de seguimiento fueron 283 (22–1118) días, con EFS global del 68%, significativamente menor en quienes recibieron alguna TLP (58% vs 100% [p = 0.070]). Múltiples TLP aportaron mayor riesgo que TLP única (p = 0.001). En conclusión, las TLP en adultos son un factor de riesgo preponderante, con mayor relevancia de lo reportado en las grandes series pediátricas.