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Craniospinal irradiation for CNS leukemia: rates of response and durability of CNS control

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Abstract

Purpose

Management of CNS involvement in leukemia may include craniospinal irradiation (CSI), though data on CSI efficacy are limited.

Methods

We retrospectively reviewed leukemia patients who underwent CSI at our institution between 2009 and 2021 for CNS involvement. CNS local recurrence (CNS-LR), any recurrence, progression-free survival (PFS), CNS PFS, and overall survival (OS) were estimated.

Results

Of thirty-nine eligible patients treated with CSI, most were male (59%) and treated as young adults (median 31 years). The median dose was 18 Gy to the brain and 12 Gy to the spine. Twenty-five (64%) patients received CSI immediately prior to allogeneic hematopoietic cell transplant, of which 21 (84%) underwent total body irradiation conditioning (median 12 Gy). Among 15 patients with CSF-positive disease immediately prior to CSI, all 14 assessed patients had pathologic clearance of blasts (CNS-response rate 100%) at a median of 23 days from CSI start. With a median follow-up of 48 months among survivors, 2-year PFS and OS were 32% (95% CI 18–48%) and 43% (95% CI 27–58%), respectively. Only 5 CNS relapses were noted (2-year CNS-LR 14% (95% CI 5–28%)), which occurred either concurrently or after a systemic relapse. Only systemic relapse after CSI was associated with higher risk of CNS-LR on univariate analysis. No grade 3 or higher acute toxicity was seen during CSI.

Conclusion

CSI is a well-tolerated and effective treatment option for patients with CNS leukemia. Control of systemic disease after CSI may be important for CNS local control. CNS recurrence may reflect reseeding from the systemic space.

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Acknowledgements

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, 98195, Seattle, WA, USA

    Maryam Ebadi, Ralph Ermoian, Lia M. Halasz, Simon S. Lo, Jonathan T. Yang, Molly H. Blau & Yolanda D. Tseng

  2. University of Washington School of Medicine, Seattle, WA, USA

    Margaret Morse

  3. Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA

    Ted Gooley, Mary-Elizabeth Percival, Ryan D. Cassaday, Vyshak Venur & Yolanda D. Tseng

  4. Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA, USA

    Mary-Elizabeth Percival, Ryan D. Cassaday & Vyshak Venur

  5. Department of Neurology, Division of Medical Oncology, University of Washington School of Medicine, Seattle, WA, USA

    Jerome Graber & Lynne P. Taylor

Authors
  1. Maryam Ebadi
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  2. Margaret Morse
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  3. Ted Gooley
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  4. Ralph Ermoian
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  5. Lia M. Halasz
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  6. Simon S. Lo
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  7. Jonathan T. Yang
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  8. Molly H. Blau
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  9. Mary-Elizabeth Percival
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  10. Ryan D. Cassaday
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  11. Jerome Graber
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  13. Vyshak Venur
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  14. Yolanda D. Tseng
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Contributions

ME: collected and analyzed the data ; wrote the main manuscript, MM: collected the data, TG: analyzed the data, RE, LH, JG, SL, JY, MB, RDC, MEP, LT and VV: provided constructive feedback and revisions, YDT: Designed and led the study and wrote the manuscript. All authors reviewed the manuscript.

Corresponding author

Correspondence to Yolanda D. Tseng.

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The authors have no relevant conflicts of interest.

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Ebadi, M., Morse, M., Gooley, T. et al. Craniospinal irradiation for CNS leukemia: rates of response and durability of CNS control. J Neurooncol 166, 351–357 (2024). https://doi.org/10.1007/s11060-023-04501-5

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  • DOI: https://doi.org/10.1007/s11060-023-04501-5

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