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Diagnosis, Prophylaxis, and Treatment of Central Nervous System Involvement in Acute Lymphoblastic Leukemia

  • Chapter
Treatment of Acute Leukemias

Part of the book series: Current Clinical Oncology ((CCO))

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Abstract

Following the first successful treatment of acute lymphoblastic leukemia (ALL) in children in the 1960s, it soon appeared that relapses occurred frequently in the cerebrospinal fluid (CSF), with 50–80% of patients affected in most series. This led to the designation of the CSF as a sanctuary site, where leukemic cells were sequestered behind the blood-brain barrier from the effects of chemotherapy (1). Various approaches were tried to overcome this barrier. The first successes came with the use of craniospinal irradiation, and then with the combination of cranial irradiation and intrathecal methotrexate (IT MTX) administered by lumbar puncture. This method was the standard during the 1970s, but it decreased in favor as long-term side effects soon became apparent: intellectual impairment (2, 3), decline in growth rate (4), and the occurrence of brain tumors as second malignancies (5, 6).

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  1. Anjo J. P. Veerman
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  1. St. Jude Children’s Research Hospital, University of Tennessee Health Science Center, Memphis, TN, USA

    Ching-Hon Pui MD

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Veerman, A.J.P. (2003). Diagnosis, Prophylaxis, and Treatment of Central Nervous System Involvement in Acute Lymphoblastic Leukemia. In: Pui, CH. (eds) Treatment of Acute Leukemias. Current Clinical Oncology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-307-1_12

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