Prevention of neuroleukemia by intrathecal administration of cytosar and methotrexate in acute lymphoblastic leukemia in adults

Aim. To find out whether efficacy of neuroleukemia (NL) prevention by intra thecal administration of cytosar and methotrexate in remission induction ph ase in adult patients with acute lymphoblastic leukemia (ALL) depends on th e risk factors. Materials and methods. The study covered 68 ALL patients. The diagnosis was made by cytological, histological and cytochemical tests of the peripheral blood and bone marrow. Immunophenotyping was performed in 48 patients. The treatment followed the German protocol 04.89 in modification of the Hemato logical Research Center of the Russian Academy of Medical Sciences. Prevent ion of NL consisted in intrathecal administration of cytosar (30 mg), metho trexate (15 mg) and dexamethasone (4 mg) once a week for 6 weeks beginning on induction day 1, further in consolidation, reinduction and once in 3 mon ths in maintenance. Radiation of the brain was not conducted. Treatment of leuroleukemia consisted of intrathecal administration of the above drugs tw ice a week up to normalization of the liquor with subsequent their administ ration 5 times and craniospinal radiation in a dose 36 Gy. Further intrathe cal administrations were made according to the protocol. Results. Correlation was not found between age of the patients and frequenc y of neuroleukemia onset, between neuroleukemia incidence and peripheral bl ood leukocytosis at diagnosis. Results of NL prevention with cytosar and me thotrexate given intrathecally in induction of remission (14.6% of neurorec urrences) are comparable with the results of NL prevention by radiation of the brain with intrathecal administration of methotrexate obtained in the G erman cooperative trial. Conclusion. NL prevention in ALL adult patients by intrathecal cytosar and methotrexate in remission induction is effective.