PROLONGED INTRATHECAL CHEMOTHERAPY REPLACING CRANIAL IRRADIATION IN HIGH-RISK ACUTE LYMPHATIC-LEUKEMIA - LONG-TERM FOLLOW-UP WITH CEREBRAL COMPUTED-TOMOGRAPHY SCANS AND ENDOCRINOLOGIC STUDIES

Cranial irradiation in children with acute lymphatic leukaemia (ALL) d ecreases the risk of CNS relapse but is associated with serious long-t erm side-effects. We present the long-term outcome of 21 children with high-risk ALL who received prolonged intrathecal chemotherapy instead of the recommended cranial irradiation. Intrathecal triple therapy (m ethotrexate, hydrocortisone, and cytarabine) was administered every 2n d month throughout the maintenance phase. The average number of course s of intrathecal methotrexate was 8.7 and of triple 9.0. The 5-year ev ent-free survival was 79%. No CNS relapses occurred. CT scan was perfo rmed at diagnosis, at cessation of therapy, and 3 years thereafter. No density abnormalities, pathological contrast enhancement, ventricular dilatation, or calcifications were found. One child showed cortical a trophy both at diagnosis and at cessation of therapy. There was a slig ht decrease in height SDS with time but no change in weight SDS. Delay ed bone age was found in 5 children. No abnornlalities of growth hormo ne, thyroid, adrenal, or gonadal function were observed. Conclusion Th e study indicates that extended intrathecal chemotherapy in children w ith high-risk ALL may provide an effective protection from CNS relapse s and is associated with a low risk of long-term side-effects.