Do you do prophylactic LP/IT chemotherapy in high risk APML prior to starting consolidation?

Extramedullary disease such as CNS involvement is quite uncommon at diagnosis in acute promyelocytic leukemia (APL). However, it can be seen in patients with relapsed disease. Both isolated CNS relapse and CNS relapse associated with morphologic or molecular relapse can occur. Yet one has the impression that CNS relapse is less commonly observed than previously, before the arsenic trioxide era with contemporary therapeutic strategies. The major possible risk factor is suggested to be the presence of high-risk disease (WBC >10,000/mcL) at diagnosis and some suggest a history of CNS hemorrhage. The role of CNS prophylaxis has not been rigorously studied. Recommendations from an expert panel of the European LeukemiaNet suggest that CNS prophyl...