Comparison of Two Methods of Preventing Central Nervous System Leukemia

During the past 10 years, 1962 to 1972, we have administered irradiation to the central nervous system (CNS) during the first few weeks of remission of acute lymphocytic leukemia (ALL) as an integral part of a treatment plan aimed at cure of ALL. Its purpose has been to eradicate residual leukemia in the CNS and thus prevent CNS relapse. The results indicate that craniospinal irradiation alone, 2400 rads, or cranial irradiation, 2400 rads, with simultaneous intrathecal methotrexate is effective in ‐preventing CNS relapse. This results in marked improvement in complete remission duration and a 50% frequency of long‐term leukemia‐free survival and possible cure. Although intermittent intrathecal methotrexate during remission is said to reduce the incidence of CNS relapse by one half, a 15‐fold reduction results from adequate preventive CNS irradiation. Until a better method is found, all children with ALL should receive adequate CNS irradiation early during remission in order to prevent CNS relapse and to prolong complete remission.

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“…Increased systemic dosage of antileukemic drugs might result i n No. 3 IRRADIATION IN CNS LEUKEMIA -Hustu et al…”

Section: Discussionmentioning

confidence: 99%

“…In Study V (Table 2), the first study in which CNS relapse was effectively prevented, the median duration of initial complete remission is the longest and the 4-year leukemia-No. 3…”

Section: Eflects Of Craniospinal Irradiation In Patients With Initialmentioning

confidence: 99%

Prevention of central nervous system leukemia by irradiation

Hustu

Aur

Verzosa

et al. 1973

Cancer

205

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“…Furthermore, the means and standard deviations were calculated and showed no statistical difference between these two study groups by t-test analysis. Although the number of patients is not large, under the conditions of this study we must No. 4 RECURRENT CHILDHOOD LYMPHO~ conclude that the administration of the intensive phase did not prolong the duration of hema tologic remissions.…”

Section: Discussionmentioning

confidence: 98%

Recurrent childhood lymphocytic leukemia following cessation of therapy.Treatment and response

Rivera¹,

Pratt²,

Aur³

et al. 1976

Cancer

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A unique population of patients--children who developed recurrent acute lymphocytic leukemia (ALL) following cessation of initial prolonged therapy--was studied. During a 2-year period, 17 such children were admitted to a planned combination chemotherapy program. Complete bone-marrow remissions were achieved in 16 patients, and the median duration of second hematologic remissions was 216 days. These responses were significantly better than those obtained in seven patients who relapsed during the administration of continuation chemotherapy. Although the rate and duration of induced remissions were notably high, 9 of the 17 patients who relapsed off therapy have again developed recurrent leukemia. This result, together with the moderate toxicity encountered during treatment, indicates that more therapy is needed. The equal proportion of bone marrow and meningeal relapses was interpreted to mean that a secon course of preventive central nervous system therapy early in remission may be especially useful.

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“…Such elective therapy could consist of either craniospinal radiotherapy, or cranial radiotherapy and intrathecal chemotherapy, or systemically administered chemotherapy that penetrates the blood brain barrier. Although spinal radiotherapy may aggravate the myelosuppression induced by chemotherapy, treatment approaches as used in the therapy of acute lymphoblastic leukemia could be devised [3]. As in acute lymphoblastic leukemia, a cure cannot be achieved unless malignant cells can be eliminated from pharmacologic sanctuary sites.…”

Section: Discussionmentioning

confidence: 99%