P14.04 Characteristics of cerebrospinal fluid in hematologic malignancy

Hematologic malignancies such as leukemia and lymphoma demonstrate leptomeningeal cell infiltration more frequently than solid tumors. Special approach in diagnosis and management is necessary, including analysis of cerebrospinal fluid (CSF) obtained from lumbar puncture (LP). The procedure of LP is more warranted among hematologic malignancy patients suspected of suffering from central nervous system (CNS) involvement. It can be performed during sessions of intrathecal chemotherapy, or as prophylactic procedure. The obtained CSF may have properties similar to CNS inflammation. There has been no specific research describing the CSF characteristics of hematologic malignancy in Indonesia; nonetheless, it is essential because, if found, the subsequent management of the patient will be quite different. Aim: To identify the characteristics of CSF in hematologic malignancy. Method: This study was retrospective study on medical records of patients with hematologic malignancy admitted to Dharmais Cancer Hospital in 2014-2015 and the Neurology wards of Cipto Mangunkusumo Hospital from 2014-2016. Inclusion criteria are subjects ≥18 years old who had pretreatment CSF analysis. Patients suspected of intracranial infection are excluded. Data collected include routine CSF analysis (cell count, glucose and protein level), cytology (presence of cancer cells), MRI (cranial or spinal), and neurologic examination. Results: 26 subjects were identified, 14 were female. Most were diagnosed with leukemia (19), Mean age was 37,4？±？13,8 years. Of 21 subjects who had cytology analysis, only five had positive results. MRI was performed on only 10 subjects, with leptomeningeal enhancement and intracranial mass lesions found in 7 subjects. Median CSF cell count was 3 (1-356)/mm3, protein level 36 (16-129)mg/dl, and glucose 63 (8-181)mg/dl. Increased cell count (>5/mm3) and protein level >45mg/dl were found in 7/26 subjects. Neurologic deficits were found on 10 subjects, most prominent being headache (7), seizures, and cranial nerve pareses. LP were performed with the indication of diagnosis based on neurologic deficits (5 with leukemia and 4 lymphoma), therapy (2 with lymphoma) and prophylaxis mainly on leukemias (14). Of 10 subjects with neurologic deficits, 3 had positive cytology. Conversely, positive cytology was found on 2 out of 16 subjects without neurologic deficits. Three positive-cytology subjects displayed leptomeningeal contrast enhancement. Negative cytology was found in one subject with enhancement, 3 with parenchymal mass lesion, and 3 with non-specific MRI features.