الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The central nervous system (CNS) involvement in hematologic malignancies is considered a major problem in acute leukemic patients. Leukemic infiltration into the CNS may lead to massive neurologic damage and if it is not detected in time might lead to disease progressive and even mortality. Meningeal infiltration by leukemic cells occurs in " ~ "5–15% of patients with acute leukemia. Diagnosis of CNS involvement requires assessment of neurologic symptoms, imaging studies, conventional cytology (CC), and most recently, flow cytometric analysis (FCM) of cerebrospinal fluid (CSF). This study aimed to determine the incidence of OCNSD in newly diagnosed adult acute leukemia patients using both CC and FCM for the analysis of CSF samples at diagnosis and to evaluate its impact on the clinical course and outcomes. Results OCNSD incidence in ALL was 58.1% (18 patients) while in AML 52.4% (11 patients). There was a significant increase in frequency of hematological relapse (P 0.006) and mortality rates (P 0.026) among patients with occult CNS involvement compared to patients without CNS involvement. Compared with patients without CNSi, ALL patients with OCNSD had inferior overall survival (OS) [64.2% vs. 11.2% at 30-months interval, P 0.002] and disease-free survival (DFS) [90.9% vs. 19.7% at 28-months interval, P 0.002]. In conclusion, FCM has greater sensitivity for the detection of CNS involvement in CSF and according to our results we recommend its performance routinely at diagnosis of acute leukemia. OCNSD (FCM+/CC-) is considered a poor prognostic factor in acute leukemia patients associated with worse response, higher relapse and mortality rates.