Abstract
The neurotoxicity resulting from the combination of cranial irradiation and intrathecal methotrexate (IT MTX) for prophylaxis of CNS leukemia led to the use of IT MTX alone in S-ALL (WBC<50,000/mm3). From July 1978 to February 1983 thirty-nine children with S-ALL (14 boys, 25 girls; ages 1-6/12 to 14-5/12 years; WBC 900-37,200/mm3) received IT MTX alone for CNS prophylaxis. All the patients received the same induction, consolidation and maintenance multi-drug systemic treatment and IT MTX alone for CNS prophylaxis. Therapy was discontinued at 3 years in those patients remaining in complete continuous remission. With a median observation period of 32+ months the following relapse rate was observed: a) isolated CNS: 3 patients (7.6%) at 11, 22, and 35 months; b) simultaneous CNS and bone marrow (BM): 1 patient (2.5%); c) BM alone: 13 patients (33%). The isolated CNS relapse rate of 7.6% utilizing IT MTX alone in S-ALL compares favorably with studies utilizing a combination of cranial irradiation and IT MTX. We conclude that the administration of IT MTX during induction and maintenance therapy provides adequate CNS prophylaxis for S-ALL and justifies the ommission of cranial irradiation in these children.
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Shende, A., Festa, R., Karayalcin, G. et al. ADEQUACY OF CHEMOPROPHYLAXIS ALONE IN PREVENTION OF CENTRAL NERVOUS SYSTEM (CNS) LEUKEMIA IN CHILDREN WITH STANDARD RISK ACUTE LYMPHOCYTIC LEUKEMIA (S-ALL). Pediatr Res 18 (Suppl 4), 248 (1984). https://doi.org/10.1203/00006450-198404001-00932
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DOI: https://doi.org/10.1203/00006450-198404001-00932