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Prevention and treatment of meningeal leukemia in children
D Pinkel and S Woo
University of Texas M.D. Anderson Cancer Center, Houston 77030.
The prevention of meningeal leukemia has long been a keystone in its cure.
The need was recognized when it became apparent in the 1950s and 1960s that
meningeal relapse heralded hematologic relapse and a fatal course and that
its incidence increased as systemic chemotherapy became more effective in
controlling hematologic and visceral leukemia. Evasion of a biologic safety
net, the blood-CSF barrier, is required to prevent meningeal leukemia.
Three methods are used: meningeal radiotherapy, intrathecal administration
of antileukemia drugs, and high-dosage intravenous antileukemia drugs.
Recent and current clinical studies reflect a continuing dialogue about
which methods are preferable and under what circumstances. For prevention
of meningeal leukemia, extended intrathecal therapy and intensive systemic
chemotherapy appear to be as effective as radiotherapy for most patients.
For treatment of overt meningeal leukemia, meningeal radiotherapy may be
necessary. However, its administration compromises subsequent systemic
chemotherapy so that delay may be advisable to allow intensive systemic
chemotherapy for control of concurrent hematologic and visceral leukemia,
whether clinically evident or not. For patients with meningeal leukemia at
diagnosis, cranial irradiation may be delayed or possibly omitted if
evidence of disease is minimal and intrathecal and systemic chemotherapy
are intensive. For those who develop meningeal leukemia while on therapy or
after its completion, cranial or craniospinal irradiation is probably
required as well as intensive intrathecal and systemic chemotherapy.
Hopefully, current and future studies will dispel the uncertainties and
better quantitate risks and benefits of alternative methods. Whatever
method is used, careful attention to technical details is required to
assure optimal efficacy at the least possible expense in immediate toxicity
and late sequelae.
Volume 84,
Issue 2,
pp. 355-366,
07/15/1994
Copyright © 1994 by The American Society of Hematology
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