Clinical Profile and Patterns of Central Nervous System Relapse in Pediatric Acute Lymphoblastic Leukemia – A Single Centre Experience

Introduction: Contemporary Chemotherapy protocols globally have reduced Central Nervous System(CNS) relapses even while eliminating Cranial Radiation (CrRT) from first-line therapy.The introduction of ICiCLe-2014 in India similarly sought to restrict CrRT to only those with CNS involvement at presentation.We looked at CNS outcomes and associated factors in children with ALL treated on ICiCLe-2014 strategy between Apr 2018-Dec 2022, with follow-up records till Apr 2024.Methodology: Children below 15-years old with newly-diagnosed ALL registered for treatment at our centre in the defined period were included.Prospectively maintained case-records were examined for data retrieval.CNS relapse was defined by presence of blasts in CSF-cytospin analysis any time after remission was achieved.Doubtful presence of blasts was confirmed by flow-cytometry.Descriptive Methodology: were used to analyze data, and statistical analysis was done on SPSS version 25.Results: There were 1413 children eligible for analysis, of which 1183(83.7%) were B-ALL and 240(16.3%)were T-ALL.CNS relapse was seen in 104(7.6%),and constituted nearly half(47.7%) of total 218 relapses.CNS was the only site of relapse in 35(33.6%),occurring within 18-months of diagnosis in 51(49%), 18-36 months in 47(45%), and 5.7% beyond 36-months at a median follow-up of 15 months.Sixtyone(58.6%) of children were symptomatic for CNS involvement at time of relapse.