Central nervous system leukemic relapse in children with acute lymphoblastic leukemia areview of 36 patients

ABSTRACT

The aims were to present the outcome of treatment of acute lymphoblastic leukemia [ALL], and to discuss the central nervous system [CNS] leukemic relapse in relation to some risk factors. Patients and Materials 36 children with acute lymphoblastic leukemia diagnosed at King Hussein Medical Center [KHMC] during a 3- year period were included in this study. All children were given the same systemic chemotherapy with triple intrathecal [TIT] chemotherapy during induction, followed by 1800-2400 cGy cranial irradiation as a prophylactic measure to prevent CNS relapse. Ten children [28%] developed bone marrow [BM] relapse, two [5.5%] testicular relapse and 5 [14%] CNS relapse. Patients with CNS relapse were treated by reinduction of chemotherapy and TIT in the form of weekly injections for 4-6 weeks and every 4-6 weeks thereafter. The median duration of CNS remission was 21 months. CNS prophylaxis therapy during induction and maintenance therapy is important in both high and standard risk groups to reduce the CNS relapse. Treating overt CNS leukemic relapse by TIT chemotherapy on a maintenance schedule, has resulted in prolonged CNS remission in hope that other modalities of treatment will be available