Central nervous system (CNS) leukemia: The role of high dose cytarabine (HDAra-C)

E. Morra, M. Lazzarino, E. P. Alessandrino, D. Inverardi, M. Regazzi Bonora, G. Pagnucco, E. Orlandi, P. Bernasconi, A. Canevari, R. Rondanelli, C. Bernasconi

Research output: Contribution to journalArticle

Abstract

Knowing the good penetration of systemic HDara-C into the CNS, we treated with this approach overt meningeal leukemia, either isolated or with bone marrow (BM) disease, in 31 adults: 18 ALL, 4 ANLL, 1 lymphoid blast crisis of CGL (LBC-CGL), and 8 non-Hodgkin's lymphoma (NHL). Treatment consisted of Ara-C, 3/m2 i.v. q 12 h, by 3 h infusion for 8 doses, followed by 4 doses at day 21. Complete remitters received consolidation with four monthly 4-dose courses of HDara-C. Additional multidrug consolidation and direct CNS therapy with intrathecal (i.t.) methotrexate (MTX) or Ara-C ± cranial RT was administered to the 11 remitters last treated. Twenty of 31 patients (64%) achieved CR: 10/10 with isolated meningeal leukemia and 10/21 with concurrent CNS and BM disease. Of the remaining 11 patients, 8 had cerebrospinal fluid (CSF) clearing with persistent BM disease. In all cases but one CNS symptoms resolved promptly. CR median duration was 6 months (range 2 to 20). The main toxicity was myelo-suppression requiring intensive support. There was no neurologic toxicity. These results show that systemic HDara-C is highly effective in acute leukemias and NHL with CNS involvement, and suggest the utility of this regimen for sanctuary chemoprophylaxis in patients at high risk for CNS disease.

Original languageEnglish
Pages (from-to)101-103
Number of pages3
JournalBone Marrow Transplantation
Volume4
Issue numberSUPPL. 1
Publication statusPublished - 1989

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Morra, E., Lazzarino, M., Alessandrino, E. P., Inverardi, D., Regazzi Bonora, M., Pagnucco, G., Orlandi, E., Bernasconi, P., Canevari, A., Rondanelli, R., & Bernasconi, C. (1989). Central nervous system (CNS) leukemia: The role of high dose cytarabine (HDAra-C). Bone Marrow Transplantation, 4(SUPPL. 1), 101-103.