COMBINATION INTRATHECAL THERAPY FOR MENINGEAL LEUKEMIA - 2 VERSUS 3 DRUGS

  • 1 January 1977
    • journal article
    • research article
    • Vol. 50  (3) , 471-479
Abstract
The comparative effectiveness of intrathecal (IT) combination chemotherapy using 2 agents, methotrexate (MTX) and hydrocortisone (HDC), and 3 agents, MTX, HDC and cytosine arabinoside (CA), in treating meningeal leukemia was determined in a randomized Southwest Oncology Group study. Following 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 2-agent therapy and 96% of 48 children given 3-agent therapy. Length of CNS remission for 2 agent therapy was 1-150 + wk, median 47.2 wk; for 3-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 2- and 3-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 were less than expected. The cytocidal activity of these agents when administered simultaneously or 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.

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