Early central nervous system involvement in adults with acute non-myelogenous leukaemia

Lister, T. Andrew; Whitehouse, J. M. A.; Beard, Michael; Paxton, A. M.; Brearley, Roger; Brown, Laura; Wrigley, P. F. M.; Crowther, D

doi:10.1038/bjc.1977.71

Cited by 25 publications

(6 citation statements)

References 8 publications

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“…Central nervous system leukaemia did not occur during the period of induction or during haematological remission, contrary to experience of Lister et al (1977) who saw 4 out of 28 patients with ALL developing meningeal involvement shortly after complete remission had occurred. Undoubtedly, the use of intrathecal methotrexate and cranial irradiation was responsible for this effect but the regular use of cytosine arabinoside which was always given i.v.…”

Section: General Adverse Effects Of Treatmentcontrasting

confidence: 70%

Treatment of adult lymphoblastic leukaemia using cyclical chemotherapy with three combinations of four drugs (COAP, POMP, TRAP schedule)

Proctor¹,

Finney²,

Walker³

et al. 1981

Postgraduate Medical Journal

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SummarySeventeen adult patients with previously untreated acute lymphoblastic leukaemia (ALL) were entered into a schedule of chemotherapy in which 3 combinations, each of 4 drugs, were administered in a predetermined cyclical rotation in combination with cranial irradiation and intrathecal injections of methotrexate. Of the 17 patients, 16 completed induction therapy and 15 (94%) entered remission. The only patient with T-ALL died before receiving any therapy. The median survival for all patients (17) was 22 months. Meningeal leukaemia did not occur during the haematological remission phase although 3 patients developed this complication following relapse. The authors conclude that the addition of cyclophosphamide and cytosine arabinoside to vincristine/prednisone provides excellent remission induction but the aggressive maintenance schedule employed has not led to significant long-term survival.

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Section: General Adverse Effects Of Treatmentcontrasting

confidence: 70%

Treatment of adult lymphoblastic leukaemia using cyclical chemotherapy with three combinations of four drugs (COAP, POMP, TRAP schedule)

Proctor¹,

Finney²,

Walker³

et al. 1981

Postgraduate Medical Journal

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“…Following the planned four or six cycles of induction therapy, 24 Gy midplane dose was delivered to the cranium in 12 fractions over 17-21 days. As meningeal infiltration may occur early in adult ALL (Lister et al, 1977) (Lister et al, 1978). In 1986, 12 patients were alive; seven were available for study.…”

Section: Patientsmentioning

confidence: 99%

“…In the light of paediatric data suggesting that proximity of CNS-P to the start of systemic therapy and the total dose of intrathecal methotrexate might influence the likelihood of subsequent problems (Lister et al, 1977;Bleyer, 1981), eight patients were identified who received less than five doses of IT methotrexate, and whose cranial irradiation was commenced within 10 weeks of diagnosis. They did not differ significantly in prevalence of neurological signs or symptoms, V-P IQ, EEG score or cerebral sulcal width when compared with the remaining 16 patients.…”

Section: Magnetic Resonance Imaging (Mri)mentioning

confidence: 99%

Minimal neuropsychological sequelae following prophylactic treatment of the central nervous system in adult leukaemia and lymphoma

Tucker

Prior²,

Green³

et al. 1989

Br J Cancer

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Summary The potential long-term toxicity of central nervous system prophylaxis (CNS-P) in adult acute lymphoblastic leukaemia (ALL, n = 17) and non-Hodgkin's lymphoma (NHL, n = 7) was investigated in a multidisciplinary study. At least 4 years had elapsed from CNS-P (mean 11.5 years) for all patients. Neurological history and physical examination were unremarkable; minor signs were commoner in older patients (P< 0.02). Psychometry yielded normal results, but individual verbal IQ generally exceeded performance IQ, with a trend to more marked differences in younger adults (P = 0.06). EEG was scored and differed significantly from that of controls, with a tendency to more marked (but still minor) abnormalities in younger patients (P = 0.06). Brainstem auditory evoked potentials demonstrated significant but generally minor abnormality in 24% of patients. CT brain scan revealed widening of cerebral hemisphere sulci to >3 mm in 38% of patients; cerebral atrophy was commoner in the older group (P< 0.02) and those with neurological signs (P<0.02). MRI brain scans were normal in all patients tested. Thus, following standard CNS-P for ALL at this hospital, there is a 5% primary CNS relapse rate, and only minimal, mainly subclinical, long-term neuropsychological toxicity.An important aspect of the 'total therapy' concept for treatment of childhood acute lymphoblastic leukaemia (ALL) is the specific prophylactic treatment of the central nervous system (CNS-P) (Aur et al., 1971; Report to the Medical Research Council, 1973). The combination of external cranial irradiation to 24 Gy with five doses of intrathecal methotrexate has reduced the primary CNS relapse rate from about 75% to 10% or less. In the late 1970s reports emerged indicating that long-term survivors of childhood ALL appeared to have subnormal IQ, typically presenting with learning difficulties (Meadows et al., 1981; Eiser et al., 1978;Moss et al., 1981;Carli et al., 1985). It is now apparent that long-term CNS problems may range in severity from minor intellectual dysfunction to severe neuropsychological damage, seizures and dementia (Bleyer, 1981).As ALL is less common in adults than in children, the former have received less attention regarding the potential neurotoxicity of CNS-P. Intensive therapy of adult ALL may now yield survival figures approaching those for children (Linker et al., 1987;Omura et al., 1980). It is therefore increasingly important to look for possible long-term adverse effects of therapy. To our knowledge there are no published data addressing this issue. The results of a multidisciplinary investigation of adults with ALL and NHL who received standard CNS-P are presented. Materials and methods PatientsAcute tymphoblastic leukaemia Between 1972 and 1982, 112 consecutive, previously (Lister et al., 1978). In 1986, 12 patients were alive; seven were available for study. Two patients were lost to follow-up, one patient refused to be studied, and two patients were excluded due to a past history of encephalitis and meningitis respectively...

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“…A third serious problem in the retrospective studies is that the physiological consequences of cancer may profoundly affect the mental and behavioral functioning of the patient. Specifically, cancer can have direct or indirect effects on brain and behavior (Bunn, Schein, Bankes, & Devita, 1976;Lister et al, 1977;Mitchell, 1967;Newman & Hansen, 1974). Direct effects such as brain metastases have been noted with bronchogenic (Newman & Hansen, 1974), lymphomic (Bunn et al, 1976), and leukemic (Lister et al, 1977) carcinoma.…”

Section: Human Studiesmentioning

confidence: 99%

Stress and cancer.

Sklar¹,

Anisman²

1981

Psychological Bulletin

314

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Consistent with the findings of human research suggesting that stress may influence the carcinogenic process, data derived from infrahuman experimentation have revealed that aversive insults may potentiate or inhibit tumorigenicity. The nature of the change, however, is dependent on a number of psychological, experiential, and organismic variables. Exacerbation of tumor growth is evident following acute exposure to uncontrollable, but not controllable, stress. Moreover, the effects of aversive stimuli vary as a function of the organism's prior stress history as well of social housing conditions. The fact that stress influences neurochemical, hormonal, and immunological functioning and that these changes are subject to many of the same manipulations that influenced the carcinogenic process suggests a relation between these three mechanisms and the stress-induced alterations of tumor growth. This contention is supported by the findings that pharmacological manipulations that modify these endogenous substrates have predictable effects on tumorigenesis.

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Early central nervous system involvement in adults with acute non-myelogenous leukaemia

Cited by 25 publications

References 8 publications

Treatment of adult lymphoblastic leukaemia using cyclical chemotherapy with three combinations of four drugs (COAP, POMP, TRAP schedule)

Treatment of adult lymphoblastic leukaemia using cyclical chemotherapy with three combinations of four drugs (COAP, POMP, TRAP schedule)

Minimal neuropsychological sequelae following prophylactic treatment of the central nervous system in adult leukaemia and lymphoma

Stress and cancer.

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