-
Blood Jul 1994The 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... (Review)
Review
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.
Topics: Child; Humans; Leukemia; Leukemia, Myeloid, Acute; Leukemic Infiltration; Meninges; Precursor Cell Lymphoblastic Leukemia-Lymphoma
PubMed: 8025264
DOI: No ID Found -
Journal of Korean Medical Science Apr 2004The involvement of central nervous system is rare in acute promyelocytic leukemia (APL). We report a APL patient of a 41 yr-old Korean male who presented with fever and... (Review)
Review
The involvement of central nervous system is rare in acute promyelocytic leukemia (APL). We report a APL patient of a 41 yr-old Korean male who presented with fever and petechia. Complete molecular remission was achieved with all-trans retinoic acid (ATRA), idarubicin, and cytarabine. Ten months later, he complained of a mild headache. The results of the physical examination and the complete blood counts were normal. The examination of cerebrospinal fluid showed the presence of promyelocyte. Bone marrow studies showed cytogenetic remission but with molecular relapse. He was treated with intrathecal and systemic chemotherapy.
Topics: Adult; Granulocyte Precursor Cells; Humans; Leukemia, Promyelocytic, Acute; Male; Meninges; Recurrence
PubMed: 15082912
DOI: 10.3346/jkms.2004.19.2.311 -
Current Opinion in Oncology Jan 1997The development of successful therapy for most children with acute lymphoblastic leukemia can be attributed to sequential clinical studies that show the importance of... (Review)
Review
The development of successful therapy for most children with acute lymphoblastic leukemia can be attributed to sequential clinical studies that show the importance of combination chemotherapy, sanctuary-specific treatment, and supportive care measures. The relative resistance of acute myelogenous leukemia to chemotherapy led to strategies that include dose-intensified chemotherapy and bone marrow transplantation. The improvement in long-term survival for children with acute leukemia has been gratifying but also has been associated with late effects that underscore the need for careful follow-up and for designing risk-adapted therapies.
Topics: Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Child; Chromosome Aberrations; Clinical Trials as Topic; Combined Modality Therapy; Cranial Irradiation; Drug Administration Schedule; Humans; Immunophenotyping; Leukemia; Leukemic Infiltration; Meninges; Multicenter Studies as Topic; Prognosis; Recurrence; Remission Induction; Risk Factors; Treatment Outcome
PubMed: 9090491
DOI: 10.1097/00001622-199701000-00005 -
American Journal of Hematology May 1993Fifteen patients with lymphoid blast crisis of chronic myelogenous leukemia (LyBC-CML) and five patients with acute lymphoblastic leukemia converting to...
Fifteen patients with lymphoid blast crisis of chronic myelogenous leukemia (LyBC-CML) and five patients with acute lymphoblastic leukemia converting to Philadelphia-positive (Ph+) chronic myeloid leukemia (ALL Ph + CML) were followed. Seven of 15 (46.7%) LyBC-CML patients developed meningeal leukemia within a median period of 6 months (range 2-11 months), while there was no medullary relapse. Five of these responded well to triple intrathecal therapy. In the ALL Ph + CML patients, in spite of central nervous system (CNS) prophylaxis with IT MTX and 18 Gy cranial radiation, two of five patients (40%) experienced meningeal leukemia, one isolated and the other with medullary relapse. The data confirm that LyBC-CML patients experience a high incidence of meningeal leukemia. The role of CNS prophylaxis is not very clear, but its use may delay development and reduce morbidity due to CNS disease.
Topics: Blast Crisis; HLA-DR Antigens; Humans; Incidence; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukemic Infiltration; Meninges; Methotrexate; Neprilysin; Radiotherapy; Survival Analysis; Time Factors
PubMed: 8317457
DOI: 10.1002/ajh.2830430104 -
Current Opinion in Oncology Jan 1996
Topics: Antineoplastic Combined Chemotherapy Protocols; Child; Humans; Leukemia; Leukemia, Promyelocytic, Acute; Meninges; Multiple Myeloma; Precursor Cell Lymphoblastic Leukemia-Lymphoma
PubMed: 8868092
DOI: No ID Found -
The American Journal of Medicine Dec 1975One hundred one patients were treated for Ph' positive chronic granulocytic leukemia (CGL) in the blastic phase. In seven of these (6.9 per cent), meningeal leukemia...
One hundred one patients were treated for Ph' positive chronic granulocytic leukemia (CGL) in the blastic phase. In seven of these (6.9 per cent), meningeal leukemia developed. Of the 99 patients who died of their disease, a complete remission was achieved in 12 with a median survival of 12 months (three to 28 months). Incomplete responders had a median survival of only 2.5 months (one to 14 months). In five of the 12 complete responders (42 per cent), but in only two of the incomplete responders (2.3 per cent), meningeal leukemia developed. The principal neurologic signs were cranial nerve palsies and papilledema. All patients had pleocytosis with myeloblasts in the cerebrospinal fluid. As in patients with acute leukemia and diffuse histiocytic lymphoma, increased survival of patients in whom hematologic remission from the blastic phase of CGL is achieved may allow sufficient time for the development of meningeal leukemia. Intrathecal methotrexate is extremely successful in treating this complication. Cerebrospinal fluid pleocytosis was eradicated in all seven of our patients, and neurologic symptoms and signs were completely eliminated in five patients. No evidence of meningeal leukemia was found in three of the five patients in whom an autopsy was performed.
Topics: Adolescent; Adult; Antineoplastic Agents; Cell Transformation, Neoplastic; Central Nervous System Diseases; Female; Humans; Leukemia; Leukemia, Myeloid; Male; Meninges; Middle Aged
PubMed: 1059328
DOI: 10.1016/0002-9343(75)90467-2 -
New York State Journal of Medicine Jul 1972
Topics: Adolescent; Adult; Female; Humans; Infant; Intracranial Pressure; Leukemia, Lymphoid; Leukemia, Myeloid; Male; Meninges; Middle Aged
PubMed: 4505438
DOI: No ID Found -
Archives of Neurology May 1986Owing to improved therapy and lengthened life span, the incidence of neuromeningeal involvement in leukemia is increasing. Careful examination of the cerebrospinal fluid...
Owing to improved therapy and lengthened life span, the incidence of neuromeningeal involvement in leukemia is increasing. Careful examination of the cerebrospinal fluid (CSF) is important for an early diagnosis. Among the available techniques, the use of cytocentrifugation enables us to demonstrate central nervous system leukemia even if the white blood cell count in the CSF is under 10/cu mm. We describe the results obtained by examining 631 CSF samples from 87 patients affected by acute leukemia; central nervous system luekemia was found in 22.7% of the patients suffering from acute lymphocytic leukemia and in 6.4% of those with acute nonlymphocytic leukemia (ANLL), but this ratio is higher in ANLL compared with the survival as measured in months (a ratio of 2.0 in ANLL compared with 0.50 in acute lymphocytic leukemia). A "leukemic" CSF was found in 51.5% of prophylactically treated patients and in 73.1% of the untreated ones.
Topics: Centrifugation; Humans; Leukemia; Leukemia, Lymphoid; Meningism
PubMed: 3964113
DOI: 10.1001/archneur.1986.00520050046020 -
Archives of Internal Medicine May 1963
Topics: Aminopterin; Humans; Leucovorin; Leukemia; Leukemia, Lymphoid; Meninges; Methotrexate
PubMed: 13973810
DOI: 10.1001/archinte.1963.03620290086011 -
Critical Reviews in Oncology/hematology Mar 2001An unforeseen consequence of improved disease-free survival in many hematologic and solid tumor malignancies has been an increase in the incidence of disease recurrence... (Review)
Review
An unforeseen consequence of improved disease-free survival in many hematologic and solid tumor malignancies has been an increase in the incidence of disease recurrence in the leptomeninges. The recognition of the central nervous system (CNS) as a unique 'sanctuary' site has resulted in the development of therapeutic strategies specifically directed at the leptomeninges. Although therapeutic strategies have been successful in the prevention and treatment of CNS leukemia, there are still a paucity of therapeutic options for patients with neoplastic meningitis due to solid tumors or recurrent CNS leukemia. This article provides an overview of the pharmacology and toxicity of intrathecal agents that are commonly employed in the treatment and prevention of leptomeningeal disease, and describes new agents that are in the early stages of clinical development.
Topics: Antineoplastic Agents; Humans; Injections, Spinal; Leukemic Infiltration; Meningeal Neoplasms; Meninges; Neoplasms
PubMed: 11248578
DOI: 10.1016/s1040-8428(00)00115-3