Meningitis leukemic

MTX is part of curative therapeutic schedules for acute lymphoblastic leukemias (ALL), Burkitt s lymphoma, and choriocarcinoma. It was also used in adjuvant therapy of breast cancer. High dose MTX with leucovorin rescue can induce about 30% remissions in patients with metastatic osteogenic sarcoma. MTX is one of the few antineoplastic drugs that can be safely administered intrathecally for the treatment of meningeal metastases and leukemic infiltrations (routine prophylaxis in ALL). In addition, MTX can be used as an immunosuppressive agent for the treatment of severe rheumatoid arthritis and psoriasis. 

A finding that continues to be frequent is that of tumor cells in CSF (Al, T5) (Table 28 Figs. 5-7, see color inserts.). Recently, there has even been an increase in the rate of detection of tumor elements, especially in hematological malignancies, where cytology is a frequent indication with respect to possible leukemic meningeal... 

A 15-year-old girl moves into your neighborhood and makes an appointment to see you. She is being treated for acute lymphoblastic leukemia. She tells you that she has been doing well, but recently she has had frequent severe headaches, and her mother said she has stumbled a couple of times during the past week for no apparent reason. She is being treated with cytarabine. If leukemic meningitis is suspected, what should be done next ... 

The goal of CNS prophylaxis is to eradicate undetectable leukemic cells from the CNS. Leukemic meningitis is more easily prevented than treated. Once CNS relapse has occnrred, patients are at increased risk of bone marrow relapse and death from refractory leukemia. Initial trials in childhood ALL in the 1960s established craniospinal irradiation as the standard for prevention of CNS relapse." However, this approach was associated with long-term seqnelae including neuropsychological deficits, precocious puberty, osteoporosis, thyroid dysfunction, an increased incidence of brain tumors, short stature, and obesity. Subseqnent trials have demonstrated that irradiation may be replaced by freqnent administration of intrathecal chemotherapy in most children with ALL."... 

Tretinoin, an oral vitamin A analog, is usually given orally in a dose of 45 mg/m per day, as a single dose or divided into two doses, given after a meal. Tretinoin-based regimens achieve CR rates as high as 95%in APL patients within 1 to 3 months. Tretinoin does not cross the blood-brain barrier therefore leukemic meningitis should be treated with conventional intrathecal chemotherapy. 

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