Traumatic lumbar puncture at diagnosis adversely affects outcome in childhood acute lymphoblastic leukemia

The effect of traumatic lumbar puncture at the time of initial diagnostic w orkup on treatment outcome in children with newly diagnosed acute lymphobla stic leukemia (ALL) was investigated. The findings of the first 2 lumbar pu nctures performed on 546 patients with newly diagnosed ALL treated on 2 con secutive front-line studies (1984-1991) at St Jude Children's Research Hosp ital were retrospectively reviewed, Lumbar punctures were performed at the time of diagnosis and again for the instillation of first intrathecal chemo therapy, The event-free survival (EFS) experience for patients with 1 cereb rospinal fluid (CSF) sample contaminated with blast cells was worse than th at for patients with no contaminated CSF samples (P = .026); that of patien ts with 2 consecutive contaminated CSF samples was particularly poor (5-yea r EFS = 46 +/- 9%), In a Cox multiple regression analysis, the strongest pr ognostic indicator was 2 consecutive contaminated CSF samples, with a hazar d ratio of 2.39 (95% confidence interval, 1.36-4.20), These data indicate t hat contamination of CSF with circulating leukemic blast cells during diagn ostic lumbar puncture can adversely affect the treatment outcome of childre n with ALL and is an indication to intensify intrathecal therapy, (C) 2000 by The American Society of Hematology.