Triple intrathecal therapy without cranial irradiation for central nervous system preventive therapy in childhood acute lymphoblastic leukemia.
BACKGROUND
To evaluate the treatment results of central nervous system preventive therapy (CNSP) with triple intrathecal therapy (TIT) alone in children with acute lymphoblastic leukemia (ALL).


METHODS
We retrospectively studied a cohort of 59 patients with median follow-up time 50.6 months (range: 27-80 months) at a single institution in Taiwan. Patients with ALL were classified in risk groups at diagnosis. TPOG-ALL-93 protocols and TPOG-ALL-2002 protocols were used. Both protocols were for multicenter studies in Taiwan and contained protocols for standard-risk (SR), high-risk (HR), and very-high-risk (VHR) patients. In this study, we used TIT alone for CNSP. In all ALL patients, methotrexate, hydrocortisone, and cytarabine were given at age-dependent doses.


RESULTS
As of October 2006, patients had a 3-year event-free survival and an overall survival 89.4 +/- 4.1% (S.E.) and 93.1 +/- 3.3%, respectively. Under TIT no patients had complications such as seizure, encephalitis, or infection, and no morbidities like those caused by cranial irradiation. In this study, we used TIT alone for CNSP and had no CNS relapse.


CONCLUSIONS
In the context of effective systemic therapy, TIT alone appears to be effective CNSP for most patients with ALL.
Lin
Wei-Ying
WY
Division of Pediatric Hematology and Oncology, Mackay Memorial Hospital, Taipei, Taiwan.
Liu
Hsi-Che
HC
Yeh
Ting-Chi
TC
Wang
Lin-Yen
LY
Liang
Der-Cherng
DC
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001215:Asparaginase / Q000494:pharmacology; D002490:Central Nervous System / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation / Q000009:adverse effects; D003520:Cyclophosphamide / Q000494:pharmacology; D003561:Cytarabine / Q000008:administration & dosage / Q000494:pharmacology; D003907:Dexamethasone / Q000008:administration & dosage; D018572:Disease-Free Survival; D015251:Epirubicin / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D007223:Infant; D007278:Injections, Spinal; D017254:Leukemic Infiltration / Q000188:drug therapy / Q000517:prevention & control*; D008297:Male; D015122:Mercaptopurine / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000473:pathology / Q000532:radiotherapy*; D011239:Prednisolone / Q000008:administration & dosage; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis; D014750:Vincristine / Q000008:administration & dosage
D003561:Cytarabine; D015251:Epirubicin; D014750:Vincristine; D003907:Dexamethasone; D003520:Cyclophosphamide; D011239:Prednisolone; D015122:Mercaptopurine; D001215:Asparaginase; D006854:Hydrocortisone; D008727:Methotrexate