The role of systemic high-dose cytarabine in the treatment of central nervous system leukemia: Clinical results in 46 patients

E. Morra, M. Lazzarino, E. Brusamolino, G. Pagnucco, C. Castagnola, P. Bernasconi, E. Orlandi, A. Corso, A. Santagostino, C. Bernasconi

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Background. Given the good penetration of systemic high-dose cytarabine (HDara-C) into the cerebrospinal fluid (CSF), this approach was used to treat patients with central nervous system (CNS) leukemia, either isolated or with concurrent extraneurologic disease (END). Methods. From 1983 to 1991, 46 adults with CNS involvement were treated with systemic HDara-C: 25 had acute lymphoblastic leukemia (ALL), 15 had high-grade non-Hodgkin lymphoma (NHL), 5 had acute myelogenous leukemia (AML), and 1 had lymphoid blast crisis of chronic myelogenous leukemia. Induction consisted of HDara-C 3 g/m2 every 12 hours, by 3-hour infusion, for 8 doses (30 patients), or 6 doses (16 patients), followed by 4 doses at day 21. Results. Of 46 patients, 29 (63%) achieved complete remission (CR): 15/15 with isolated CNS leukemia, and 14/31 (45%) with CNS and concurrent marrow or lymph node disease. Of 17 patients not meeting CR criteria because of persistent END, 11 showed complete CNS response. The first 10 remitters were consolidated with monthly 4-dose courses of HDara-C. The remaining 19 received postinduction multidrug chemotherapy (including vincristine, doxorubicin, cyclophosphamide, L- asparaginase, etoposide plus intermediate-dose ara-C, mitoxantrone plus HDara-C) and intrathecal methotrexate (MTX) ± cranial radiation therapy. One patient underwent autologous and one allogeneic bone marrow transplant. Median CR duration was 7 months (range, 2-56+): 8 months for patients with isolated CNS leukemia, and 4 months for those with concurrent END. In only two patients was CNS the primary site of relapse. Three patients with isolated CNS leukemia are disease-free at 23, 40, and 56 months. The main toxicity was myelosuppression. No patient showed dose-limiting neurologic toxicity. Conclusions. Systemic HDara-C appears effective therapy for CNS leukemia, maximally in cases with isolated CNS involvement. HDara-C may be combined safely with cranial radiation therapy and intrathecal MTX. This approach for CNS leukemia, however, needs to be combined with additional treatments to eradicate residual disease in extraneurologic compartments.

Original languageEnglish
Pages (from-to)439-445
Number of pages7
JournalCancer
Volume72
Issue number2
Publication statusPublished - 1993

Fingerprint

Cytarabine
Leukemia
Central Nervous System
Therapeutics
Methotrexate
Non-Hodgkin's Lymphoma
Radiotherapy
Bone Marrow
Blast Crisis
Asparaginase
Mitoxantrone
Central Nervous System Diseases
Vincristine
Etoposide
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Acute Myeloid Leukemia
Doxorubicin
Cyclophosphamide
Nervous System

Keywords

  • acute leukemia
  • central nervous system leukemia
  • high-dose cytarabine
  • non-Hodgkin lymphoma

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

The role of systemic high-dose cytarabine in the treatment of central nervous system leukemia : Clinical results in 46 patients. / Morra, E.; Lazzarino, M.; Brusamolino, E.; Pagnucco, G.; Castagnola, C.; Bernasconi, P.; Orlandi, E.; Corso, A.; Santagostino, A.; Bernasconi, C.

In: Cancer, Vol. 72, No. 2, 1993, p. 439-445.

Research output: Contribution to journalArticle

Morra, E, Lazzarino, M, Brusamolino, E, Pagnucco, G, Castagnola, C, Bernasconi, P, Orlandi, E, Corso, A, Santagostino, A & Bernasconi, C 1993, 'The role of systemic high-dose cytarabine in the treatment of central nervous system leukemia: Clinical results in 46 patients', Cancer, vol. 72, no. 2, pp. 439-445.
Morra, E. ; Lazzarino, M. ; Brusamolino, E. ; Pagnucco, G. ; Castagnola, C. ; Bernasconi, P. ; Orlandi, E. ; Corso, A. ; Santagostino, A. ; Bernasconi, C. / The role of systemic high-dose cytarabine in the treatment of central nervous system leukemia : Clinical results in 46 patients. In: Cancer. 1993 ; Vol. 72, No. 2. pp. 439-445.
@article{3349da76712e4e5babb734e57acf3989,
title = "The role of systemic high-dose cytarabine in the treatment of central nervous system leukemia: Clinical results in 46 patients",
abstract = "Background. Given the good penetration of systemic high-dose cytarabine (HDara-C) into the cerebrospinal fluid (CSF), this approach was used to treat patients with central nervous system (CNS) leukemia, either isolated or with concurrent extraneurologic disease (END). Methods. From 1983 to 1991, 46 adults with CNS involvement were treated with systemic HDara-C: 25 had acute lymphoblastic leukemia (ALL), 15 had high-grade non-Hodgkin lymphoma (NHL), 5 had acute myelogenous leukemia (AML), and 1 had lymphoid blast crisis of chronic myelogenous leukemia. Induction consisted of HDara-C 3 g/m2 every 12 hours, by 3-hour infusion, for 8 doses (30 patients), or 6 doses (16 patients), followed by 4 doses at day 21. Results. Of 46 patients, 29 (63{\%}) achieved complete remission (CR): 15/15 with isolated CNS leukemia, and 14/31 (45{\%}) with CNS and concurrent marrow or lymph node disease. Of 17 patients not meeting CR criteria because of persistent END, 11 showed complete CNS response. The first 10 remitters were consolidated with monthly 4-dose courses of HDara-C. The remaining 19 received postinduction multidrug chemotherapy (including vincristine, doxorubicin, cyclophosphamide, L- asparaginase, etoposide plus intermediate-dose ara-C, mitoxantrone plus HDara-C) and intrathecal methotrexate (MTX) ± cranial radiation therapy. One patient underwent autologous and one allogeneic bone marrow transplant. Median CR duration was 7 months (range, 2-56+): 8 months for patients with isolated CNS leukemia, and 4 months for those with concurrent END. In only two patients was CNS the primary site of relapse. Three patients with isolated CNS leukemia are disease-free at 23, 40, and 56 months. The main toxicity was myelosuppression. No patient showed dose-limiting neurologic toxicity. Conclusions. Systemic HDara-C appears effective therapy for CNS leukemia, maximally in cases with isolated CNS involvement. HDara-C may be combined safely with cranial radiation therapy and intrathecal MTX. This approach for CNS leukemia, however, needs to be combined with additional treatments to eradicate residual disease in extraneurologic compartments.",
keywords = "acute leukemia, central nervous system leukemia, high-dose cytarabine, non-Hodgkin lymphoma",
author = "E. Morra and M. Lazzarino and E. Brusamolino and G. Pagnucco and C. Castagnola and P. Bernasconi and E. Orlandi and A. Corso and A. Santagostino and C. Bernasconi",
year = "1993",
language = "English",
volume = "72",
pages = "439--445",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "2",

}

TY - JOUR

T1 - The role of systemic high-dose cytarabine in the treatment of central nervous system leukemia

T2 - Clinical results in 46 patients

AU - Morra, E.

AU - Lazzarino, M.

AU - Brusamolino, E.

AU - Pagnucco, G.

AU - Castagnola, C.

AU - Bernasconi, P.

AU - Orlandi, E.

AU - Corso, A.

AU - Santagostino, A.

AU - Bernasconi, C.

PY - 1993

Y1 - 1993

N2 - Background. Given the good penetration of systemic high-dose cytarabine (HDara-C) into the cerebrospinal fluid (CSF), this approach was used to treat patients with central nervous system (CNS) leukemia, either isolated or with concurrent extraneurologic disease (END). Methods. From 1983 to 1991, 46 adults with CNS involvement were treated with systemic HDara-C: 25 had acute lymphoblastic leukemia (ALL), 15 had high-grade non-Hodgkin lymphoma (NHL), 5 had acute myelogenous leukemia (AML), and 1 had lymphoid blast crisis of chronic myelogenous leukemia. Induction consisted of HDara-C 3 g/m2 every 12 hours, by 3-hour infusion, for 8 doses (30 patients), or 6 doses (16 patients), followed by 4 doses at day 21. Results. Of 46 patients, 29 (63%) achieved complete remission (CR): 15/15 with isolated CNS leukemia, and 14/31 (45%) with CNS and concurrent marrow or lymph node disease. Of 17 patients not meeting CR criteria because of persistent END, 11 showed complete CNS response. The first 10 remitters were consolidated with monthly 4-dose courses of HDara-C. The remaining 19 received postinduction multidrug chemotherapy (including vincristine, doxorubicin, cyclophosphamide, L- asparaginase, etoposide plus intermediate-dose ara-C, mitoxantrone plus HDara-C) and intrathecal methotrexate (MTX) ± cranial radiation therapy. One patient underwent autologous and one allogeneic bone marrow transplant. Median CR duration was 7 months (range, 2-56+): 8 months for patients with isolated CNS leukemia, and 4 months for those with concurrent END. In only two patients was CNS the primary site of relapse. Three patients with isolated CNS leukemia are disease-free at 23, 40, and 56 months. The main toxicity was myelosuppression. No patient showed dose-limiting neurologic toxicity. Conclusions. Systemic HDara-C appears effective therapy for CNS leukemia, maximally in cases with isolated CNS involvement. HDara-C may be combined safely with cranial radiation therapy and intrathecal MTX. This approach for CNS leukemia, however, needs to be combined with additional treatments to eradicate residual disease in extraneurologic compartments.

AB - Background. Given the good penetration of systemic high-dose cytarabine (HDara-C) into the cerebrospinal fluid (CSF), this approach was used to treat patients with central nervous system (CNS) leukemia, either isolated or with concurrent extraneurologic disease (END). Methods. From 1983 to 1991, 46 adults with CNS involvement were treated with systemic HDara-C: 25 had acute lymphoblastic leukemia (ALL), 15 had high-grade non-Hodgkin lymphoma (NHL), 5 had acute myelogenous leukemia (AML), and 1 had lymphoid blast crisis of chronic myelogenous leukemia. Induction consisted of HDara-C 3 g/m2 every 12 hours, by 3-hour infusion, for 8 doses (30 patients), or 6 doses (16 patients), followed by 4 doses at day 21. Results. Of 46 patients, 29 (63%) achieved complete remission (CR): 15/15 with isolated CNS leukemia, and 14/31 (45%) with CNS and concurrent marrow or lymph node disease. Of 17 patients not meeting CR criteria because of persistent END, 11 showed complete CNS response. The first 10 remitters were consolidated with monthly 4-dose courses of HDara-C. The remaining 19 received postinduction multidrug chemotherapy (including vincristine, doxorubicin, cyclophosphamide, L- asparaginase, etoposide plus intermediate-dose ara-C, mitoxantrone plus HDara-C) and intrathecal methotrexate (MTX) ± cranial radiation therapy. One patient underwent autologous and one allogeneic bone marrow transplant. Median CR duration was 7 months (range, 2-56+): 8 months for patients with isolated CNS leukemia, and 4 months for those with concurrent END. In only two patients was CNS the primary site of relapse. Three patients with isolated CNS leukemia are disease-free at 23, 40, and 56 months. The main toxicity was myelosuppression. No patient showed dose-limiting neurologic toxicity. Conclusions. Systemic HDara-C appears effective therapy for CNS leukemia, maximally in cases with isolated CNS involvement. HDara-C may be combined safely with cranial radiation therapy and intrathecal MTX. This approach for CNS leukemia, however, needs to be combined with additional treatments to eradicate residual disease in extraneurologic compartments.

KW - acute leukemia

KW - central nervous system leukemia

KW - high-dose cytarabine

KW - non-Hodgkin lymphoma

UR - http://www.scopus.com/inward/record.url?scp=0027238057&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027238057&partnerID=8YFLogxK

M3 - Article

C2 - 8319175

AN - SCOPUS:0027238057

VL - 72

SP - 439

EP - 445

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 2

ER -