In children with acute lymphoblastic leukemia, delaying first first triple intrathecal therapy (TIT) until disappearance of peripheral blood blasts may be beneficial, according to one study. Researchers evaluated the administration of TIT without cranial irradiation (CrRT) in 152 children with newly diagnosed ALL at disappearance of blasts or up until 10 days of multidrug induction. Results showed four patients experienced traumatic lumbar punctures, although none had lymphoblast contamination. Five-year event free and overall survival rates were 84.2% and 90.6%, respectively. Isolated CNS relapse did not occur in any patients, but combined relapse occurred in two patients. Cumulative risk for CNS relapse was 1.7% at 7 years, according to the data. These results suggest that delaying first TIT until peripheral blood blasts disappear may improve CNS control and eliminate the need for CrRT, thereby preventing the toxicities and risks associated with the treatment, in this patient population, the researchers wrote.
The purpose of this study was to eliminate the toxicities and sequelae of cranial irradiation (CrRT) and to minimize the adverse impact of traumatic lumbar puncture (TLP) with blasts in children with acute lymphoblastic leukemia (ALL). Since June 1999, children with newly diagnosed ALL have been treated with triple intrathecal therapy (TIT) alone without CrRT.