-transparent.png){kind=logo}
Fourteen children were treated for isolated meningeal relapse occurring seven to 44 months (median, 14 months) after prophylactic cranial irradiation (2,400 rad/12 fractions) and intrathecal methotrexate (IT MTX, 12 mg/m2 for four doses during cranial irradiation). Eight had "high-risk" acute lymphocytic leukemia with age less than 2 years, white blood cell counts greater than 20,000, or T cell markers. Treatment for central nervous system leukemia included IT MTX (12 mg/m2 twice weekly until clearance of spinal fluid cytology) followed by craniospinal irradiation (CSI, 3,000 rad/20 fractions to the cranium and 1,800 rad/12 fractions to the spine). No maintenance IT MTX was given. Systemic chemotherapy was continued or reinstituted for a minimum of one year after CSI. No instance of second meningeal relapse has occurred. Five patients remain in secondary complete remission 66+, 54+, 36+, 26+, and 24+ months after meningeal relapse. Disease-free survival was limited by marrow relapse in eight patients (2-20 months after CSI) and testicular relapse in one. No acute toxicities were noted with CSI. Myelosuppression occurred in seven patients. Infections within two months of CSI were noted in five. No neurologic sequelae are apparent. Serial neuropsychometric studies in 10 patients revealed a significant decline in mean values on Global IQ scales. Long-term survival with acceptable toxicity is possible following aggressive, prompt treatment of meningeal relapse occurring after prophylactic cranial irradiation. Hematologic relapse remains the major obstacle to long-term disease-free survival.
L E Kun, and
B M Camitta, and
R K Mulhern, and
S J Lauer, and
R W Kline, and
J T Casper, and
B A Kamen, and
B M Kaplan, and
S W Barber
November 1979,
Klinische Padiatrie,
L E Kun, and
B M Camitta, and
R K Mulhern, and
S J Lauer, and
R W Kline, and
J T Casper, and
B A Kamen, and
B M Kaplan, and
S W Barber
January 1992,
Zhonghua Minguo xiao er ke yi xue hui za zhi [Journal]. Zhonghua Minguo xiao er ke yi xue hui,
L E Kun, and
B M Camitta, and
R K Mulhern, and
S J Lauer, and
R W Kline, and
J T Casper, and
B A Kamen, and
B M Kaplan, and
S W Barber
February 1995,
International journal of radiation oncology, biology, physics,
L E Kun, and
B M Camitta, and
R K Mulhern, and
S J Lauer, and
R W Kline, and
J T Casper, and
B A Kamen, and
B M Kaplan, and
S W Barber
January 1982,
Klinische Padiatrie,
L E Kun, and
B M Camitta, and
R K Mulhern, and
S J Lauer, and
R W Kline, and
J T Casper, and
B A Kamen, and
B M Kaplan, and
S W Barber
January 1984,
Nouvelle revue francaise d'hematologie,
L E Kun, and
B M Camitta, and
R K Mulhern, and
S J Lauer, and
R W Kline, and
J T Casper, and
B A Kamen, and
B M Kaplan, and
S W Barber
January 2010,
Asian Pacific journal of cancer prevention : APJCP,
L E Kun, and
B M Camitta, and
R K Mulhern, and
S J Lauer, and
R W Kline, and
J T Casper, and
B A Kamen, and
B M Kaplan, and
S W Barber
June 2011,
Clinical advances in hematology & oncology : H&O,
L E Kun, and
B M Camitta, and
R K Mulhern, and
S J Lauer, and
R W Kline, and
J T Casper, and
B A Kamen, and
B M Kaplan, and
S W Barber
July 2002,
International journal of hematology,
L E Kun, and
B M Camitta, and
R K Mulhern, and
S J Lauer, and
R W Kline, and
J T Casper, and
B A Kamen, and
B M Kaplan, and
S W Barber
June 1993,
[Rinsho ketsueki] The Japanese journal of clinical hematology,
L E Kun, and
B M Camitta, and
R K Mulhern, and
S J Lauer, and
R W Kline, and
J T Casper, and
B A Kamen, and
B M Kaplan, and
S W Barber
June 2000,
Medical and pediatric oncology,
