Journal of Clinical Oncology, Vol 2, 359-364, Copyright © 1984 by American Society of Clinical Oncology

ARTICLES

Treatment of meningeal relapse in childhood acute lymphoblastic leukemia. I. Results of craniospinal irradiation

LE Kun, BM Camitta, RK Mulhern, SJ Lauer, RW Kline, JT Casper, BA Kamen, BM Kaplan and SW Barber

Fourteen children were treated for isolated meningeal relapse occurring seven to 44 months (median, 14 months) after prophylactic cranial irradiation (2,400 rad/12 fractions) and intrathecal methotrexate (IT MTX, 12 mg/m2 for four doses during cranial irradiation). Eight had "high-risk" acute lymphocytic leukemia with age less than 2 years, white blood cell counts greater than 20,000, or T cell markers. Treatment for central nervous system leukemia included IT MTX (12 mg/m2 twice weekly until clearance of spinal fluid cytology) followed by craniospinal irradiation (CSI, 3,000 rad/20 fractions to the cranium and 1,800 rad/12 fractions to the spine). No maintenance IT MTX was given. Systemic chemotherapy was continued or reinstituted for a minimum of one year after CSI. No instance of second meningeal relapse has occurred. Five patients remain in secondary complete remission 66+, 54+, 36+, 26+, and 24+ months after meningeal relapse. Disease-free survival was limited by marrow relapse in eight patients (2-20 months after CSI) and testicular relapse in one. No acute toxicities were noted with CSI. Myelosuppression occurred in seven patients. Infections within two months of CSI were noted in five. No neurologic sequelae are apparent. Serial neuropsychometric studies in 10 patients revealed a significant decline in mean values on Global IQ scales. Long-term survival with acceptable toxicity is possible following aggressive, prompt treatment of meningeal relapse occurring after prophylactic cranial irradiation. Hematologic relapse remains the major obstacle to long-term disease-free survival.
CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				W. Lee, S. J. Kim, S. Lee, J. Kim, M. Kim, J. Lim, Y. Kim, B. Cho, E. J. Lee, and K. Han Significance of Cerebrospinal Fluid sIL-2R Level as a Marker of CNS Involvement in Acute Lymphoblastic Leukemia Ann. Clin. Lab. Sci., October 1, 2005; 35(4): 407 - 412. [Abstract] [Full Text] [PDF]

				A. K. Ritchey, B. H. Pollock, S. J. Lauer, Y. Andejeski, and G. R. Buchanan Improved Survival of Children With Isolated CNS Relapse of Acute Lymphoblastic Leukemia: A Pediatric Oncology Group Study J. Clin. Oncol., December 1, 1999; 17(12): 3745 - 3752. [Abstract] [Full Text] [PDF]

				M. C. Chamberlain Topical Review: A Review of Leptomeningeal Metastases in Pediatrics J Child Neurol, May 1, 1995; 10(3): 191 - 199. [Abstract] [PDF]