251
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Jaime-Pérez JC, Rodríguez-Romo LN, González-Llano O, Chapa-Rodríguez A, Gómez-Almaguer D. Effectiveness of intrathecal rituximab in patients with acute lymphoblastic leukaemia relapsed to the CNS and resistant to conventional therapy. Br J Haematol 2009; 144:794-5. [DOI: 10.1111/j.1365-2141.2008.07497.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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252
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Janzen LA, Spiegler BJ. Neurodevelopmental sequelae of pediatric acute lymphoblastic leukemia and its treatment. ACTA ACUST UNITED AC 2009; 14:185-95. [PMID: 18924154 DOI: 10.1002/ddrr.24] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This review will describe the neurocognitive outcomes associated with pediatric acute lymphoblastic leukemia (ALL) and its treatment. The literature is reviewed with the aim of addressing methodological issues, treatment factors, risks and moderators, special populations, relationship to neuroimaging findings, and directions for future research. It is concluded that neurocognitive outcomes for the majority of children with standard-risk ALL treated according to current chemotherapy protocols is relatively good, but subgroups of children are more significantly compromised. As medical treatments advance and survival rates continue to improve, neurocognitive outcomes and other quality of life indicators will become increasingly important. Preventing or ameliorating treatment-related neuropsychological sequelae represents the next major challenge in pediatric ALL.
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Affiliation(s)
- Laura A Janzen
- Department of Psychology, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.
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253
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Brugnoletti F, Morris EB, Laningham FH, Patay Z, Pauley JL, Pui CH, Jeha S, Inaba H. Recurrent intrathecal methotrexate induced neurotoxicity in an adolescent with acute lymphoblastic leukemia: Serial clinical and radiologic findings. Pediatr Blood Cancer 2009; 52:293-5. [PMID: 18831032 PMCID: PMC2605174 DOI: 10.1002/pbc.21764] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Systemic and intrathecal methotrexate (MTX) are integral components of acute lymphoblastic leukemia (ALL) therapy, but can be associated with neurotoxicity. We describe here the case of an adolescent male with T-cell ALL who developed recurrent episodes of subacute neurotoxicity characterized by slurred speech, emotional lability, and hemiparesis after intrathecal MTX administration. Serial magnetic resonance imaging with diffusion-weighted imaging showed recurrent areas of restricted diffusion within cerebral hemispheric white matter, which correlated chronologically with the administration of intrathecal therapy and severity of clinical symptoms. Resolution of diffusion abnormalities did not preclude further toxicity and a large lesion could cause persisting symptoms.
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Affiliation(s)
- Fulvia Brugnoletti
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - E. Brannon Morris
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN,Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Fred H. Laningham
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN,Department of Radiology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Zoltán Patay
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN,Department of Radiology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Jennifer L Pauley
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN,College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN,Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Sima Jeha
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN,Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Hiroto Inaba
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN,Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN
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254
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ANDIC F, ORS Y, NIANG U, KUZHAN A, DIRIER A. Dosimetric comparison of conventional helmet-field whole-brain irradiation with three-dimensional conformal radiotherapy: dose homogeneity and retro-orbital area coverage. Br J Radiol 2009; 82:118-22. [DOI: 10.1259/bjr/37984200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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256
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Kwong YL, Yeung DYM, Chan JCW. Intrathecal chemotherapy for hematologic malignancies: drugs and toxicities. Ann Hematol 2008; 88:193-201. [PMID: 19050889 DOI: 10.1007/s00277-008-0645-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Accepted: 11/11/2008] [Indexed: 11/25/2022]
Abstract
Intrathecal (IT) chemotherapy is an important component of the prophylaxis or treatment of hematologic malignancies in the central nervous system (CNS), especially in patients with acute lymphoblastic leukemia and aggressive lymphomas. Different regimens of IT chemotherapies have been formulated, often in conjunction with systemic high-dose chemotherapy leading to penetration of the drugs into the cerebrospinal fluid (CSF). The three commonest IT drugs are methotrexate, cytosine arabinoside (Ara-C), and corticosteroids. The CSF half-lives of methotrexate and Ara-C are much prolonged, a factor to be considered if these drugs are also administered systemically in high doses. Neurotoxicities attributed to IT chemotherapy have been reported, including spinal cord lesions, seizures, and encephalopathy. Spinal cord lesions, manifesting as tetraplegia, paraplegia, and cauda equina syndrome, are the commonest neurotoxicity. It is mostly related to combined IT methotrexate and Ara-C, or Ara-C as the sole IT agent when given at high doses or as a slow-release preparation. Cord lesions rarely recover and patients are left with motor deficits, bowel and urinary disabilities. Seizures and encephalopathy are reported in relatively fewer patients, with variable manifestations and prognosis. Knowledge of the pharmacokinetics, dosing schedules and potential toxicities of IT chemotherapeutic drugs is important in the design of CNS prophylaxis and treatment in hematologic malignancies.
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Affiliation(s)
- Yok-Lam Kwong
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China.
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257
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Affiliation(s)
- Deepa Bhojwani
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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258
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Lipton J, Joffe S, Ullrich NJ. CNS relapse of acute myelogenous leukemia masquerading as pseudotumor cerebri. Pediatr Neurol 2008; 39:355-7. [PMID: 18940560 DOI: 10.1016/j.pediatrneurol.2008.07.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 07/21/2008] [Accepted: 07/23/2008] [Indexed: 10/21/2022]
Abstract
An 18-year-old man in remission from acute myelogenous leukemia 3 years after a bone marrow transplant presented with signs of pseudotumor cerebri, including headache, visual changes, and papilledema. He manifested elevated opening pressure on lumbar puncture and positive cytology, with a concurrent normal bone marrow aspirate and biopsy. He was diagnosed with an isolated central nervous system relapse of acute myeloid leukemia. Although the precise etiology remains elusive, this case demonstrates that pseudotumor cerebri must remain within the differential diagnosis after other complications are excluded, particularly in persons with underlying hematologic malignancies.
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Affiliation(s)
- Jonathan Lipton
- Department of Neurology, Children's Hospital Boston, Boston, Massachusetts, 02115, USA
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