Intraventricular concentration times time (CxT) methotrexate and cytarabine for patients with recurrent meningeal leukemia and lymphoma

BACKGROUND. Intraventricular chemotherapy results in more uniform drug dist ribution within the subarachnoid space and allows for more flexible drug ad ministration schedules. The authors report their experience with an intrave ntricular concentration times time (C x T) chemotherapy regimen for recurre nt meningeal leukemia and lymphoma. METHODS. Twenty-one patients (median age, 11.6 years) received C x T therap y for meningeal acute lymphoblastic leukemia (n = 18), Burkitt's lymphoma ( n = 2), or undifferentiated leukemia (n = 1). Prior therapy included standa rd intrathecal (IT) methotrexate and cytarabine, cranial or craniospinal ra diation (median, 24 Gy), and 0-5 experimental treatment modalities. C x T i nduction therapy consisted of 2 mg of intraventricular methotrexate adminis tered daily for 3 days every 10 days, for 4 courses. Patients were then con solidated with 4 courses of alternating intraventricular cytarabine (15 mg/ day) or methotrexate (2 mg/day) daily for 3 days every 2 weeks (2 courses o f methotrexate and 2 courses of cytarabine). Maintenance therapy consisted of alternating monthly courses of C x T methotrexate or cytarabine. RESULTS. Ninety-three percent of patients (14 of 15) who were evaluable for response achieved a complete remission in a median of 10 days (range, 2-40 days). Median remission duration was 15 months. Fourteen patients died of recurrent disease or systemic treatment-related complications; 2 patients a re alive, off treatment, and in continuous complete remission for 59+ and 8 9+ months; 1 patient experienced a meningeal relapse at 24 months on C x T therapy but was reinduced with the C x T regimen, received craniospinal rad iation, and is in remission at 142+ months; and 3 are alive with disease at 32+, 72+, and 81+ months. One patient was lost to follow-up. CONCLUSIONS. This regimen appears to be an effective and well-tolerated pal liative treatment for patients with recurrent meningeal leukemia and lympho ma. (C) 1999 American Cancer Society.