The role of supine and prone positions on central nervous system involvement in patients with acute lymphoblastic leukemia

Acute lymphoblastic leukemia (ALL) affects both children and adults, with a peak incidence between the ages of 2 and 5 years. ALL cells sometimes penetrate the central nervous system (CNS) and patients with CNS diseases at initial presentation have been reported to experience a significantly greater risk of treatment failure compared with CNS negative patients. This study hypothesized that the prone position may reduce the CNS involvement compared with the supine position, therefore the aim of this study was to evaluate the role of supine and prone positions on CNS involvement in ALL patients.

This randomized clinical trial was conducted on 38 patients with ALL admitted in Shahid saddughi Hospital from 2006 to 2016. In this study, 14 patients received prophylaxis intrathecal chemotherapy with post-injection supine position (control group) and 22 patients received prophylaxis intrathecal chemotherapy with post-injection prone position (intervention group) White blood cell (WBC) count (CNS involvement) was evaluated in two groups.

Among 22 patients in the intervention group, 16 (72.7%) were males, and 6 (27.3%) were females and of the 14 patients in the control group, 8 (57.1%) were males and 6 (42.9%) were females. The difference in the mean WBCs in the cerebrospinal fluid between the two groups was as follows: the mean WBCs in the control group was 8.7143 and the mean WBCs in the intervention group was 4.9524. The difference between the two groups was statistically significant (P-value =0.039). However, no significant difference was seen between the two groups in terms of sex, age, and duration of disease (p>0.05).

The incidence of CNS involvement was significantly decreased when patients were placed in the post-puncture prone position for 3 hours.