β2‐Microglobulin, lysozyme and lactoferrin in cerebrospinal fluid in patients with lymphoma or leukaemia: relationship to CNS involvement and the effect of prophylactic intrathecal treatment with methotrexate

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Abstract
Central nervous system (CNS) involvement in patients with leukemia or lymphoma presents a diagnostic problem. This study was conducted to test whether combined measurements of various cellular markers such as .beta.2-microglobulin (.beta.2m), lactoferrin (LF) and lysozyme (LYS) in the cerebrospinal fluid (CSF) might aid in the diagnosis of CNS involvement in such patients. Forty-two patients were studied. Sixteen were considered to have CNS involvement and 26 showed no signs of such involvement. In the group with symptoms or signs of CNS involvement, nine patients out of 12 had increased total protein in CSF, 14 of 14 increased .beta.2m, 14 of 16 increased LYS and five of 15 increased LF. In patients without CNS involvement total protein was increased in four of 25, .beta.2m in three of 21, LYS in four of 28 and LF in one of 28 patients. The differences were statistically significant (P < 0.01, P < 0.001, P < 0.001 and P < 0.05, respectively). Prophylactic intrathecal methotrexate treatment in patients with acute lymphoblastic leukemia caused an increase in the CSF of .beta.2m, LYS and LF but not of total protein, which may reflect a drug-induced inflammatory reaction in the CNS. We conclude that combined measurements of the three cell markers add to our understanding of the cellular reaction to malignant cells in the CNS in leukemia and lymphoma and may be valuable supplements in the diagnosis of this CNS involvement.