SOLUBLE L-SELECTIN INCREASES IN THE CEREBROSPINAL-FLUID PRIOR TO MENINGEAL INVOLVEMENT IN CHILDREN WITH ACUTE LYMPHOBLASTIC-LEUKEMIA

Soluble L-selectin was determined in the CSF samples of 20 children wi th CNS leukemia at the time they had blasts in CSF and/or clinical fin dings of CNS involvement; 17 CSF fluid samples were obtained from 17 o f these 20 children, 29-91 days before the appearance of CSF cytologic al and/or clinical findings of CNS involvement; while 15 CSF samples w ere withdrawn from among the same group of children, after treatment o f meningeal leukemia. In addition, CSF sL-selectin was also assayed in 17 children with ALL, who remained in complete remission at least fcr a year and, as controls, in 12 children without malignant or meningea l disorders. There was no significant difference in CSF sl-selectin le vels between the children with ALL without evidence of meningeal invol vement and the controls (1.34 +/- 0.21 ng/ml, 1.46 +/- 0.18 ng/ml resp ectively, p > 0.05). However, in children with CNS leukemia, not only at the time CNS involvement was diagnosed, but also 29-91 days before the diagnosis of CNS leukemia, the concentrations of the CSF sL-select in (12.41 +/- 2.14 ng/ml, 7.70 +/- 1.60 ng/ml respectively) were signi ficantly higher than those in controls (p < 0.001 and p < 0.01 respect ively). After treatment and disappearance of the blasts in CSF, sl-sel ectin was found to be decreased and even normalized in the majority of children who had meningeal involvement (2.87 +/- 2.14 ng/ml). In 5 ch ildren, the CSF sL-selectin remained high, after the blasts in CSF had disappeared and CNS leukemia recurred within 3 months in 4 of these 5 children. In conclusion, assay of sl-selectin in CSF seems to be a go od diagnostic tool in the detection of CNS involvement in children wit h ALL. This method may also be used as an indicator, in prediction of the CNS leukemia, which is going to develop.