Prevention of neuroleukemia by intrathecal administration of cytosar and methotrexate in acute lymphoblastic leukemia in adults

AIM: To find out whether efficacy of neuroleukemia (NL) prevention by intrathecal administration of cytosar and methotrexate in remission induction phase in adult patients with acute lymphoblastic leukemia (ALL) depends on the risk factors. MATERIALS AND METHODS: The study covered 68 ALL patients. The diagnosis was made by cytological, histological and cytochemical tests of the peripheral blood and bone marrow. Immunophenotyping was performed in 48 patients. The treatment followed the German protocol 04.89 in modification of the Hematological Research Center of the Russian Academy of Medical Sciences. Prevention of NL consisted in intrathecal administration of cytosar (30 mg), methotrexate (15 mg) and dexamethasone (4 mg) once a week for 6 weeks beginning on induction day 1, further in consolidation, reinduction and once in 3 months in maintenance. Radiation of the brain was not conducted. Treatment of leuroleukemia consisted of intrathecal administration of the above drugs twice a week up to normalization of the liquor with subsequent their administration 5 times and craniospinal radiation in a dose 36 Gy. Further intrathecal administrations were made according to the protocol. RESULTS: Correlation was not found between age of the patients and frequency of neuroleukemia onset, between neuroleukemia incidence and peripheral blood leukocytosis at diagnosis. Results of NL prevention with cytosar and methotrexate given intrathecally in induction of remission (14.6% of neurorecurrences) are comparable with the results of NL prevention by radiation of the brain with intrathecal administration of methotrexate obtained in the German cooperative trial. CONCLUSION: NL prevention in ALL adult patients by intrathecal cytosar and methotrexate in remission induction is effective.