title: Phase 2 clinical trial of intrathecal topotecan in children with refractory leptomeningeal leukemia: a Children's Oncology Group trial (P9962).
abstract: OBJECTIVE
  We performed a phase 2 study in children with recurrent or refractory leptomeningeal leukemia to determine the objective response rate after treatment with intrathecal (IT) topotecan.
  
  
  METHODS
  Patients received age-adjusted IT topotecan (0.4 mg/dose for patients >3 years of age) administered twice weekly (every 3-4 days) for 6 weeks during induction, weekly for 4 weeks during consolidation, and twice monthly for 4 months and then monthly thereafter during maintenance.
  
  
  RESULTS
  Twenty-two patients enrolled in the study, of whom 20 were eligible and assessable for toxicity and 16 were assessable for response. Of 16 patients, 6 (38%) had a complete response, 8 (50%) had stable disease, and 2 (13%) had progressive disease. The median event-free survival time (95% CI) was 3.1 (1.6-10.3) months and the median overall survival time (95% CI) was 18.0 (7.3-38.3) months. Eight patients (40%) experienced grade 3 or 4 adverse events. There were no grade 4 neurological events (Table III). Four patients experienced a total of 6 grade 3 neurological events including an olfactory seizure, a headache, transient grade 3 speech impairment, muscle weakness, motor neuropathy, and ataxia. Headache was the most common grade ≤2 neurologic event and two patients developed grade ≤2 arachnoiditis.
  
  
  CONCLUSIONS
  IT administration of topotecan was tolerable on this dose and schedule. The majority of adverse events were mild to moderate, reversible side effects. Complete central nervous system remissions were achieved in a subset of children with recurrent or refractory central nervous system leukemia.
authors: Baylor College of Medicine, Houston, TX 77030, USA.
authors: Samara L Poplack
authors: SL
authors: Potter
authors: Stacey
authors: S
authors: Berg
authors: Ashish Mark
authors: AM
authors: Ingle
authors: Mark
authors: M
authors: Krailo
authors: Peter C
authors: PC
authors: Adamson
authors: Susan M
authors: SM
authors: Blaney
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007278:Injections, Spinal; D007938:Leukemia / Q000188:drug therapy*; D008297:Male; D008577:Meningeal Neoplasms / Q000188:drug therapy*; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D016019:Survival Analysis; D059004:Topoisomerase I Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D019772:Topotecan / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
chemical_list: D059004:Topoisomerase I Inhibitors; D019772:Topotecan