Background. This study describes the incidenceof acute neurotoxicity (NT) in childrenwith B-lineage acute lymphoblastic leukemia(ALL) treated with three intermediate risk protocolsthat differ in the intensity of central nervoussystem (CNS) “prophylaxis.” Procedure. Atotal of 122 patients (64 boys; median age 5.3years) with B-lineage ALL without CNS leukemiadiagnosed between February 1987 and December1997 were enrolled in the intermediaterisk (IR) protocols: Associazione Italiana diEmatologia ed Oncologia Pediatrica (AIEOP)-ALL 87 (n = 33), 91 (n = 51), and 95 (n = 38).Presymptomatic CNS therapy consisted of intrathecalmethotrexate (six doses) and cranialirradiation (18 Gy) in the IR AIEOP 87 study,and extended triple intrathecal therapy withmethotrexate, cytarabine, and prednisone dependingon age in the IR AIEOP-ALL 91 and 95protocols (20 and 17 total doses, respectively).World Health Organization (WHO) grade 4acute neurotoxicity criteria were employed. Patientswith neurologic symptoms, in addition tophysical examination, underwent EEG, computedtomography (CT) and/or magnetic resonanceimaging (MRI), and lumbar puncture toexclude CNS leukemia and infection. Results.Acute NT was not reported in AIEOP-ALL 87treated patients, but we observed acute NT in 3out of 51 (5.8%) AIEOP-ALL 91 patients, and in7 out of 38 (18.4%) AIEOP-ALL 95 patients.Conclusions. There was an increased incidenceof acute NT in our patients with ALL treatedwith current intermediate risk protocols. The intensificationof treatment, however, betteredevent free survival (EFS) to 58%, 72% and 85%in IR AIEOP 87, 91 and 95 studies, respectively.
Acute neurotoxicity in children with B-lineage acute lymphoblastic leukemia treated with intermediate risk protocols
DI CATALDO, Andrea;
2000-01-01
Abstract
Background. This study describes the incidenceof acute neurotoxicity (NT) in childrenwith B-lineage acute lymphoblastic leukemia(ALL) treated with three intermediate risk protocolsthat differ in the intensity of central nervoussystem (CNS) “prophylaxis.” Procedure. Atotal of 122 patients (64 boys; median age 5.3years) with B-lineage ALL without CNS leukemiadiagnosed between February 1987 and December1997 were enrolled in the intermediaterisk (IR) protocols: Associazione Italiana diEmatologia ed Oncologia Pediatrica (AIEOP)-ALL 87 (n = 33), 91 (n = 51), and 95 (n = 38).Presymptomatic CNS therapy consisted of intrathecalmethotrexate (six doses) and cranialirradiation (18 Gy) in the IR AIEOP 87 study,and extended triple intrathecal therapy withmethotrexate, cytarabine, and prednisone dependingon age in the IR AIEOP-ALL 91 and 95protocols (20 and 17 total doses, respectively).World Health Organization (WHO) grade 4acute neurotoxicity criteria were employed. Patientswith neurologic symptoms, in addition tophysical examination, underwent EEG, computedtomography (CT) and/or magnetic resonanceimaging (MRI), and lumbar puncture toexclude CNS leukemia and infection. Results.Acute NT was not reported in AIEOP-ALL 87treated patients, but we observed acute NT in 3out of 51 (5.8%) AIEOP-ALL 91 patients, and in7 out of 38 (18.4%) AIEOP-ALL 95 patients.Conclusions. There was an increased incidenceof acute NT in our patients with ALL treatedwith current intermediate risk protocols. The intensificationof treatment, however, betteredevent free survival (EFS) to 58%, 72% and 85%in IR AIEOP 87, 91 and 95 studies, respectively.File | Dimensione | Formato | |
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