中枢神经系统白血病（CNSL）仍然是急性髓系白血病（AML）患者的严重并发症，也是接受异基因造血干细胞移植（allo-HSCT）患者的模糊预后因素。目前尚不清楚使用更灵敏的工具，例如多参数流式细胞术 (MFC) 来检测脑脊液 (CSF) 中的原始细胞是否会对结果产生影响。我们回顾性分析了 1472 名接受或不接受细胞学检查或不接受细胞学检查的 AML 患者的临床结果。移植前脑脊液中 MFC 呈阳性。 44名患者在诊断后的任何时间通过常规细胞学和MFC检测到异常脑脊液（CSF）。根据性别、移植时年龄和诊断时白细胞计数，通过倾向评分匹配 (PSM) 分析产生 175 名脑脊液正常 (CSF-) 患者的对照组。与脑脊液阴性组相比，传统细胞学阳性组和 MFC 组的 8 年非复发死亡率 (NRM) 相当（4%、4% 和 6%，p = 0.82），累积复发率 (CIR) 较高（14%、31% 和 32%） ，p = 0.007），较低的无白血病生存率 (LFS)（79%、63% 和 64%，p = 0.024）和总生存率 (OS)（83%、63% 和 68%，p = 0.021 ），常规细胞学阳性组和MFC组之间无显着差异。此外，多变量分析证实脑脊液受累是影响 OS 和 LFS 的独立因素。我们的结果表明，移植前 CSF 异常是独立影响 AML 患者同种异体移植后 OS 和 LFS 的不利因素。© 2024 John Wiley

Central nervous system leukemia (CNSL) remains a serious complication in patients with acute myeloid leukemia (AML) and an ambiguous prognostic factor for those receiving allo-geneic hematopoiesis stem cell transplantation (allo-HSCT). It is unknown whether using more sensitive tools, such as multiparameter flow cytometry (MFC), to detect blasts in the cerebrospinal fluid (CSF) would have an impact on outcome.We retrospectively analyzed the clinical outcomes of 1472 AML patients with or without cytology or MFC positivity in the CSF before transplantation. Abnormal CSF (CSF+) was detected via conventional cytology and MFC in 44 patients at any time after diagnosis. A control group of 175 CSF-normal (CSF-) patients was generated via propensity score matching (PSM) analyses according to sex, age at transplant, and white blood cell count at diagnosis.Compared to those in the CSF-negative group, the conventional cytology positive and MFC+ groups had comparable 8-year nonrelapse mortality (NRM) (4%, 4%, and 6%, p = 0.82), higher cumulative incidence of relapse (CIR) (14%, 31%, and 32%, p = 0.007), lower leukemia-free survival (LFS) (79%, 63%, and 64%, p = 0.024), and overall survival (OS) (83%, 63%, and 68%, p = 0.021), with no significant differences between the conventional cytology positive and MFC+ groups. Furthermore, multivariate analysis confirmed that CSF involvement was an independent factor affecting OS and LFS.Our results indicate that pretransplant CSF abnormalities are adverse factors independently affecting OS and LFS after allotransplantation in AML patients.© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.