Neurotoxicity Following Intrathecal Chemotherapy

In a phase II study, intrathecal liposomal cytarabine was associated with unexpected neurotoxicity in some ALL patients who received concomitant high-dose intravenous methotrexate and cytarabine.

Patients with acute lymphoblastic leukemia (ALL) have substantial risk for developing leptomeningeal leukemia; thus, central nervous system (CNS) prophylaxis with intrathecal (IT) methotrexate and cytarabine is a well-established component of induction therapy. Liposomal cytarabine (DepoCyt), an FDA-approved agent for treatment of lymphomatous meningitis, is of interest for CNS prophylaxis because it is effective for treating active leptomeningeal disease and, due to its depot formulation, can be administered less frequently than standard cytarabine.

Investigators at the M.D. Anderson Cancer Center conducted a phase II study of liposomal cytarabine IT prophylaxis (3 to 6 treatments) in conjunction with the hyper-CVAD (cyclophosphamide, vincr…

Reviewing Author

Michael E. Williams, MD