title: Intrathecal chemoprophylaxis after HSCT in children.
abstract: At present, the literature on the efficacy and risks of i.t. chemotherapy to children after HSCT is scarce. Current practices to reduce the risk of leukemic relapse in the CNS after HSCT differ between centers of transplantation. We compared 74 patients (56 ALL/18 AML), who received i.t. therapy post-HSCT with 46 patients (36 ALL/10 AML) who did not receive post-HSCT i.t. therapy. The patients were transplanted at the University Children's Hospital, Uppsala or the Karolinska University Hospital, Huddinge, two Swedish transplantation units with different routines concerning i.t. therapy after HSCT. The primary end-point was the number of isolated CNS relapses. Secondary end-points were other types of relapse, death, and neurological complications. There was no statistically significant difference in the incidence of CNS relapses between the groups (p > 0.05). I.t. therapy did not reduce the overall incidence of isolated CNS relapse or mortality. Our study did not demonstrate a protective effect of i.t. therapy indicating that post-HSCT i.t. therapy may only be of limited use in the treatment of acute childhood leukemia. We conclude that with the risks present, i.t. therapy should be carefully evaluated, and only considered in high-risk cases.
authors.affiliation: Department of Pediatrics, Karolinska University Hospital-Huddinge, Karolinska Institutet, Stockholm, Sweden. johanna.rubin@karolinska.se
authors.forename: Johanna
authors.initials: J
authors.lastname: Rubin
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Frost
authors.forename: Johan
authors.initials: J
authors.lastname: Arvidson
authors.forename: Katarina
authors.initials: K
authors.lastname: Wide
authors.forename: Asa
authors.initials: A
authors.lastname: Gustafsson-Jernberg
authors.forename: Britt
authors.initials: B
authors.lastname: Gustafsson
mesh_terms: D000293:Adolescent; D002490:Central Nervous System / Q000473:pathology; D018890:Chemoprevention; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007278:Injections, Spinal; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D012008:Recurrence; D033581:Stem Cell Transplantation / Q000379:methods*; D016896:Treatment Outcome