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Recently, we have shown that flow cytometric CD7\/CADM1 analysis of CD4\u2009+\u2009cells (HAS-Flow) is useful to detect ATL cells that are not morphologically diagnosed as ATL cells. We investigated the role of CNS involvement in ATL\u00a0using\u00a0cytology and HAS-Flow by analyzing cerebrospinal fluid (CSF) from 73 aggressive ATL cases. Based on the findings in CSF, the study subjects were classified into CNS\u2009+\u2009(cytologically malignant, <jats:italic>n<\/jats:italic>\u2009=\u200918), CNS- (cytologically non-malignant and ATL cell population negative in HAS-Flow, <jats:italic>n<\/jats:italic>\u2009=\u200944), and CNS-Micro (cytologically non-malignant and ATL cell population positive in HAS-Flow, <jats:italic>n<\/jats:italic>\u2009=\u200911) groups. As expected, the CNS\u2009+\u2009group had a shorter overall survival than the CNS- groups (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). However, the CNS-Micro group\u00a0showed no adverse impact on overall survival compared to the CNS- group (<jats:italic>P<\/jats:italic>\u2009=\u20090.506),\u00a0even without additional CNS-targeted treatments. HAS-Flow also demonstrated clinical utility in the diagnosis of CSF lesions in ATL patients with cerebral white matter lesions and in the detection of ATL cells on post-treatment CSF examination in patients with CNS involvement. Our study demonstrates that ATL with CNS involvement have a poor prognosis and that CSF HAS-Flow is useful to assist in the diagnosis of suspected CNS involvement and to detect ATL cells with high sensitivity after treatment.<\/jats:p>","DOI":"10.1007\/s00277-025-06186-4","type":"journal-article","created":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T23:48:24Z","timestamp":1736466504000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognosis of aggressive adult T-cell leukemia\/lymphoma with central nervous system infiltration and utility of CD7 versus CADM1 flowcytometric plots of cerebrospinal fluid"],"prefix":"10.1007","author":[{"given":"Koji","family":"Jimbo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomohiro","family":"Ishigaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masataka","family":"Sakashita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shohei","family":"Andoh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirona","family":"Ichimura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayumu","family":"Ito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuaki","family":"Yokoyama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aki","family":"Sato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahiro","family":"Fukuda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaoru","family":"Uchimaru","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuhito","family":"Nannya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,1,10]]},"reference":[{"issue":"3","key":"6186_CR1","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1182\/blood.V50.3.481.481","volume":"50","author":"T Uchiyama","year":"1977","unstructured":"Uchiyama T, Yo J, Sagawa K, Takatsuki K, Uchino H (1977) Adult T-cell leukemia: clinical and hematologic features of 16 cases. 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