Efficacy and morbidity of central nervous system "prophylaxis" in childhood acute lymphoblastic leukemia: eight years' experience with cranial irradiation and intrathecal methotrexate

Abstract

Between 1972 and 1979, 214 children with acute lymphoblastic leukemia and no evidence of central nervous system (CNS) disease prior to CNS prophylaxis were treated with 2400 rad cranial irradiation and concurrent intrathecal methotrexate. Only nine children developed CNS leukemia; five of them in the CNS only and four concurrently in the CNS and another site. Major acute effects of CNS prophylaxis were seizures in seven patients (3%). Sixty-nine children who had a minimum follow-up of 4 yr were evaluable for late effects of therapy. Small cataracts, incomplete regrowth of hair, and learning disabilities were noted. The latter occurred in 18% of patients, an incidence similar to that encountered in a normal community of school-age children. However, the incidence of learning disabilities in patients who were under 5 yr of age at the time of diagnosis was much higher, 35%. We conclude that the combination of cranial irradiation and intrathecal methotrexate was highly efficacious. The incidence and severity of neuropsychologic abnormalities, the principal late morbidity of this treatment program, varies among reporting institutions. Prospective longitudinal studies of neuropsychologic function are necessary to better define the incidence of abnormalities. Future programs should attempt to decrease late morbidity, but must also assure equal efficacy and improve overall disease-free survival.

Functional and structural differences in the hippocampus associated with memory deficits in adult survivors of acute lymphoblastic leukemia

“…ALL has a propensity to spread to the CNS and thus treatment includes prophylactic CNS therapy. The latter is associated with frequent and well‐documented long‐term cognitive sequelae 1, 24–29. Historically, CNS treatment included whole brain radiation and intrathecal chemotherapy; however, because of the long‐term cognitive sequelae of cranial radiation, current CNS treatments omit radiation for a large majority of children with ALL and use both intrathecal and systemic chemotherapy only.…”

Ocular abnormalities at diagnosis and after the completion of treatment in children and adolescents with newly diagnosed acute lymphoblastic leukemia

“…The incidence of cataract in children treated for ALL varies among studies and is generally reported to not significantly impact vision 2,20–24 . In our cohort, new cataract formation was the most frequent abnormality after the conclusion of therapy and was associated with higher occurrence of vision deficits.…”

“…The incidence of cataract in children treated for ALL varies among studies and is generally reported to not significantly impact vision. 2,[20][21][22][23][24] In our cohort, new cataract formation was the most frequent abnormality after the conclusion of therapy and was associated with higher occurrence of vision deficits. We observed a cumulative incidence of cataract of 13% at 43 months from diagnosis, and additional cases were registered with longer follow-up.…”

Verlauf der meningealen Tumoraussaat - Analyse von 85 Patienten

“…Sekundllre Mallgnome spielen als Therapiefolge der Meningealkarzinose keine Rolien, können jedod nadh Jahren bzw. mntrathekai prophyiaktisdher Be-handlung Bedeutung erlangen (17). So berichtete Fontana (11) uber insgesamt 17 Patienten, die mehrere Jahre nach erfoigreich behandelter ALL vornehmlich Astrozytome Grad III und IV sowie Glioblastome im Alter zwischen 9 und 17 Jahren entwickelten.…”

“…Nebenwir/cungen von intrathekal MTX allein oder kombiniert mit Strahientherapie sind(8,9,17,29,42,47): Arachnitis: Akuteinsetzen der Symptomatik innerhath von 24-72 Stunden nach intrathekaler MTX-Applikation mit Kopfschmerz, Ubelkeit und Erbrechen. Diese Kompilkation ist bei unseren Patienten nicht dokumentiert (in der Literatur 5-40%, zit.…”