Radiation in Central Nervous System Leukemia: Guidelines From the International Lymphoma Radiation Oncology Group

Abstract

Consensus Statements Effective central nervous system (CNS) prophylaxis for acute lymphoid leukemia requires systemic and intrathecal-directed therapy, with radiation therapy (RT) considered rarely and on a case-by-case basis for patients with high-risk features. For patients with overt CNS leukemia at diagnosis or those who develop CNS leukemia at the onset of disease relapse, RT should be considered, especially when other CNS-directed therapy has failed. For patients undergoing allogeneic hematopoietic stem cell transplantation, comprehensive RT to the CNS should be considered for patients with acute lymphoid leukemia or acute myeloid leukemia who have a history of CNS involvement. We recommend a minimal interval of 2 weeks between the last intravenous or intrathecal administration of methotrexate or cytarabine and initiation of CNS-directed RT. However, in cases in which urgent RT is necessary because of symptoms, shorter intervals of 48 to 72 hours may be considered. The choice of comprehensive (ie, craniospinal irradiation) or limited RT to the CNS should depend on the expected long-term outcomes for each individual patient. High suspicion for therapy-related neurotoxicity should always be maintained for heavily pretreated patients who present with CNS-related symptoms. The recommended RT dose can vary from 18 to 24 Gy.

Cell-Type-Specific Proteogenomic Signal Diffusion for Integrating Multi-Omics Data Predicts Novel Schizophrenia Risk Genes

“…This finding is in concordance with the well-established observations that Neuroligin protein members act as ligands for Neuroxins, resulting in the connections between neurons and generation of synapses. 49 CASK and AFDN have also been implicated in CNS diseases such intellectual disabilities 50 , 51 and CNS leukemia, 52 , 53 respectively. Given that AFDN interacts with NRXN3 , 54 we can conclude that MAPSD is capable of recovering high-risk loci in protein complexes and can infer converging disease risk modules in the human interactome.…”

Acute Lymphoblastic Leukemia Presenting Initially as Spinal Cord Compression: When Chemotherapy Alone Is Enough

“…Surgery and radiation will delay the administration of systemic chemotherapy, as chemotherapy may impact wound healing following surgery, and concurrent chemotherapy and radiation may increase myelosuppression. If spinal irradiation is initiated, intrathecal or systemic chemotherapy cannot be initiated within 48-72 hours of radiation [16]. With surgical intervention and radiation, a minimum two-week delay in systemic treatment (due to the radiation normally delivered over ten days) could result in the aforementioned complications and could further delay or alter the systemic treatment plan which may ultimately cure the underlying malignancy.…”

Cell type-specific proteogenomic signal diffusion for integrating multi-omics data predicts novel schizophrenia risk genes

“…This finding is in concordance with the well-established observations that Neuroligin protein members act as ligands for Neuroxins, resulting in the connections between neurons and generation of synapses 48 . CASK and AFDN have also been implicated in CNS diseases such intellectual disabilities 49,50 and CNS leukemia 51,52 , respectively. Given that AFDN interacts with NRXN3 53 , we can conclude that MAPSD is capable of recovering high-risk loci in protein complexes and can infer a big picture of the converging disease-risk modules in the human interactome.…”