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Combination intrathecal therapy for meningeal leukemia: two versus three
drugs
MP Sullivan, TE Moon, R Trueworthy, TJ Vietti, GB Humphrey and D Komp
The comparative effectiveness of intrathecal (IT) combination chemotherapy
using two agents, methotrexate (MTX) and hydrocortisone (HDC), and three
agents, MTX, HDC, and cytosine arabinoside (CA), in treating meningeal
leukemia was determined in a randomized Southwest Oncology Group study.
Following central nervous system (CNS) remission induction the same regimen
was used for periodic maintenance until CNS relapse supervened. Complete
CNS remission was achieved in 100% of 43 children given two-agent therapy
and in 96% of 48 children given three- agent therapy. Length of CNS
remission for two-agent therapy was 1-150+ wk, median 47.2 wk; for
three-agent therapy, remissions were 1-190+ wk, median 64.6 wk. Differences
in length of remission curves were not of statistical significance
(p=0.71). Toxicity of combination IT chemotherapy in the two- and
three-agent regimens was reduced compared to that of IT MTX alone for CNS
remission induction and maintenance. The additive effects of the IT drug
combinations have been less than expected. The cytocidal activity of these
agents when administered simultaneously of sequentially is not fully
understood. Further studies are clearly indicated to determine optimum
doses, schedules, and sequences for the chemotherapeutic agents which can
be given intrathecally in combination.
Volume 50,
Issue 3,
pp. 471-479,
09/01/1977
Copyright © 1977 by The American Society of Hematology
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