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Pediatric Drugs

, Volume 20, Issue 4, pp 293–301 | Cite as

The Use of Ommaya Reservoirs to Deliver Central Nervous System-Directed Chemotherapy in Childhood Acute Lymphoblastic Leukaemia

  • Ruairi Wilson
  • Caroline Osborne
  • Christina HalseyEmail author
Therapy in Practice

Abstract

Prophylactic eradication of central nervous system (CNS) leukaemia is the current standard of care in treating childhood acute lymphoblastic leukaemia (ALL). This is conventionally achieved through regular lumbar punctures with intrathecal injections of methotrexate into the cerebrospinal fluid (CSF). Ommaya reservoirs are subcutaneous implantable devices that provide a secure route of drug delivery into the CSF via an intraventricular catheter. They are an important alternative in cases where intrathecal injection via lumbar puncture is difficult. Among UK Paediatric Principal Treatment Centres for ALL we found considerable variation in methotrexate dosing when using an Ommaya reservoir. We review the current safety and theoretical considerations when using Ommaya reservoirs and evidence for methotrexate dose adjustments via this route. We conclude by summarising the pragmatic consensus decision to use 50% of the conventional intrathecal dose of methotrexate when it is administered via Ommaya reservoir in front-line ALL therapy.

Notes

Acknowledgements

The authors would like to thank all the participating UK Paediatric Principal Treatment Centres for providing data on current dosing strategies and the UK Childhood Leukaemia Clinicians Network for review of the data and agreement of a consensus approach.

Compliance with Ethical Standards

Funding

There was no external funding for this work.

Conflict of interest

Ruairi Wilson, Caroline Osborne, and Christina Halsey declare that they have no conflicts of interest that might be relevant to the contents of this manuscript.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
  2. 2.Pharmacy DepartmentAlder Hey Children’s NHS Foundation TrustLiverpoolUK
  3. 3.Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK

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