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Cerebrospinal fluid findings in patients with hematologic neoplasms and meningeal infiltration

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Abstract

Neoplastic cell infiltration into the central nervous system (CNS) is a serious complication of hematological neoplasms. Cytomorphology (CM) and flow cytometry (FC) have been used to detect meningeal infiltration. The association between CSF findings with the results of CM and FC is still poorly understood. We retrospectively evaluated CSF findings in 72 patients with hematological neoplasm and meningeal infiltration detected either by CM or FC. We compared CSF cell count, total protein concentration, and lactate concentration according to the type of hematological neoplasm. We also compared these CSF findings according to the FC and CM results (FC + CM + , FC + CM-, and FC-CM +). The proportion of patients with positive FC was higher than with CM (FC − 91.7%; CM − 63.9%). Thirty-five (48.6%) patients with meningeal infiltration had normal CSF cell count, normal total protein concentration, and normal lactate concentration. The proportion of cases in which these CSF parameters were normal did not differ according to the type of hematological neoplasm. The positivity of CM was significantly higher in patients with > 3 cell/mm3 (P = 0.015) but the positivity of FC was not significantly different between patients with > 3 cell/mm3 or ≤ 3 cells/mm3. Patients with positive CM had more CSF cells (P = 0.0005) and higher lactate concentration (P = 0.0165) than patients with negative CM. The absence of CSF changes in cell count and total protein and lactate concentrations does not exclude the presence of meningeal infiltration. Although CM is considered the gold standard, the probability of positive CM is low in patients without CSF abnormalities in these parameters. Patients with hematological neoplasm with suspected meningeal infiltration should be investigated with both methods.

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Authors and Affiliations

  1. Senne Liquor Diagnóstico, São Paulo, SP, Brazil

    Renan Barros Domingues, Fernando Brunale Vilela de Moura Leite & Carlos Senne

Authors
  1. Renan Barros Domingues
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  2. Fernando Brunale Vilela de Moura Leite
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  3. Carlos Senne
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by RBD, FBVML and CS. The first draft of the manuscript was written by RBD and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Renan Barros Domingues.

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The authors declare that they have no conflict of interest.

Ethical statement

The human tissue and fluid samples analyzed were obtained from patients routinely subjected to CSF analysis irrespective of this study. The study did not offer any direct benefits to patients or interfere with patient diagnosis or treatment.

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Informed consent was obtained from each participant before CSF collection.

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Domingues, R.B., de Moura Leite, F.B.V. & Senne, C. Cerebrospinal fluid findings in patients with hematologic neoplasms and meningeal infiltration. Acta Neurol Belg 121, 1543–1546 (2021). https://doi.org/10.1007/s13760-020-01397-0

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  • DOI: https://doi.org/10.1007/s13760-020-01397-0

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