Intrathecal Chemotherapy (Part I): First 100 Sequentials Procedures and Its Acute Complications. Technique and Safety (P01.101)

OBJECTIVE: To present the results of the first 100 sequential intrathecal chemotherapy (IT-ChT) procedures with an “ad hoc” technique and surveillance for immediate side effects. BACKGROUND: The lumbar puncture (LP) to deliver IT-ChT is a well-known procedure. Nevertheless, the information in the English-Spanish literature of the technique for the IT-ChT application or recommendations to prevent or reduce the complications expected from this procedure is scarce. DESIGN/METHODS: Between 2002-2005 we performed 100 instillations of ChT agents (prophylactic or therapeutic) in 28 patients with different types of lymphoma and leukemia, and one testicular malignant teratoma. Chemotherapy preparation was performed either by a nurse or one of our team, using cytotoxic drug reconstitution either with water or 0.9% Sodium Chloride. The brand name of the drug was not taken into account. The procedure was standardized as follows: a) N° 21 LP needle; b) patient in lateral recumbent position; c) LP needle introduced with bevel up/downward; d) with or without taking samples of CSF for analysis; e) first syringe with dexamethasone (4-8 mg); second syringe with methotrexate (12-15 mg); and third syringe with Cytosine arabinoside (33-36 mg) f) 0.5 ml were delivered every 15 seconds; g) for every ml that was introduced, 0.25 ml were aspirated; h) removal of LP needle with syringe in position. Clinical and neurologic surveillance to detect adverse events within one hour of the procedure. RESULTS: We observed 37/100 complications; 36 were paresthesias (33 without pain, painful in 3), 20 of these lasted for 5, 5 lasted 10, 8 between 10and 30, and 3 between 30and 70. One patient had myoclonias with painful spasm and D12 sensitive level that disappeared in 50. Three cases of post-PL headache were observed. CONCLUSIONS: The IT-ChT procedure following this technique was safe. We observed immediate minor complications to be aware of at the time of performing the IT-ChT. Supported by: Scholarship Peruilh-Menvielle, School of Medicine, University of Buenos Aires. Disclosure: Dr. Casas Parera has nothing to disclose. Dr. Rudy has received personal compensation for activities with Bristol-Myers Squibb Company. Dr. Cardozo-Oliver has nothing to disclose. Dr. Baez has nothing to disclose. Dr. Baez has nothing to disclose. Dr. Horsburgh has received personal compensation for activities with Roche.