Vol 8, No 3 (2017)
Case report
Published online: 2017-11-23
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Lymphocytic meningitis after intrathecal liposomal cytarabine in a patient with acute lymphoblastic leukemia
Hematologia 2017;8(3):228-233.
Abstract
Central nervous system (CNS) involvement at diagnosis of acute lymphoblastic leukemia (ALL) is found in approximately 5% of patients and is a poor prognosis factor. Introduction of prophylactic strategies reduced involvements rate from 30% to 10% at relapse. Prophylactic regimens include: intrathecal chemotherapy (methotrexate, cytarabine [Ara-C], dexamethasone), irradiation of the whole brain, and systemic chemotherapy penetrating to CNS. Liposomal Ara-C is a prolonged-release formulation of Ara-C dedicated to intrathecal use. Its half-time is about 2 weeks. It has been used in prophylaxis and treatment regimens. Clinical trials proved its better efficacy and patients’ quality of life than its standard formulation. However, in comparison with classic triple intrathe¬cal therapy, using liposomal Ara-C may have higher risk of neurotoxicity. In the paper we report a case of 47-years-old patient with pre-T ALL who after third injection of liposomal Ara-C developed a symptomless lymphocytic meningitis with the maximal cytosis in cerebrospinal fluid of 1600 cells/μl. The review of the literature on neurotoxicity of liposomal Ara-C is hereby presented.
Keywords: acute lymphoblastic leukemialiposomal cytarabineneurotoxicitymeningitis
References
- Reman O, Pigneux A, Huguet F, et al. GET-LALA group. Central nervous system involvement in adult acute lymphoblastic leukemia at diagnosis and/or at first relapse: results from the GET-LALA group. Leuk Res. 2008; 32(11): 1741–1750.
- Lazarus HM, Richards SM, Chopra R, et al. Medical Research Council (MRC)/National Cancer Research Institute (NCRI) Adult Leukaemia Working Party of the United Kingdom and the Eastern Cooperative Oncology Group. Central nervous system involvement in adult acute lymphoblastic leukemia at diagnosis: results from the international ALL trial MRC UKALL XII/ECOG E2993. Blood. 2006; 108(2): 465–472.
- Jabbour E, Thomas D, Cortes J, et al. Central nervous system prophylaxis in adults with acute lymphoblastic leukemia: current and emerging therapies. Cancer. 2010; 116(10): 2290–2300.
- Bleyer WA, Dedrick RL. Clinical pharmacology of intrathecal methotrexate. I. Pharmacokinetics in nontoxic patients after lumbar injection. Cancer Treat Rep. 1977; 61(4): 703–708.
- Murry DJ, Blaney SM. Clinical pharmacology of encapsulated sustained-release cytarabine. Ann Pharmacother. 2000; 34(10): 1173–1178.
- Kim S, Chatelut E, Kim JC, et al. Extended CSF cytarabine exposure following intrathecal administration of DTC 101. J Clin Oncol. 1993; 11(11): 2186–2193.
- Glantz MJ, LaFollette S, Jaeckle KA, et al. Randomized trial of a slow-release versus a standard formulation of cytarabine for the intrathecal treatment of lymphomatous meningitis. J Clin Oncol. 1999; 17(10): 3110–3116.
- Chamberlain MC, Khatibi S, Kim JC, et al. Treatment of leptomeningeal metastasis with intraventricular administration of depot cytarabine (DTC 101). A phase I study. Arch Neurol. 1993; 50(3): 261–264.
- Glantz MJ, LaFollette S, Jaeckle KA, et al. Randomized trial of a slow-release versus a standard formulation of cytarabine for the intrathecal treatment of lymphomatous meningitis. J Clin Oncol. 1999; 17(10): 3110–3116.
- Chamberlain MC, Kormanik P, Howell SB, et al. Pharmacokinetics of intralumbar DTC-101 for the treatment of leptomeningeal metastases. Arch Neurol. 1995; 52(9): 912–917.
- Bomgaars L, Geyer JR, Franklin J, et al. Phase I trial of intrathecal liposomal cytarabine in children with neoplastic meningitis. J Clin Oncol. 2004; 22(19): 3916–3921.
- Parasole R, Petruzziello F, Messina C, et al. Toxicity and efficacy of intrathecal liposomal cytarabine in children with leukemia/lymphoma relapsing in the central nervous system: a retrospective multicenter study. Leuk Lymphoma. 2015; 56(3): 650–655.
- Benesch M, Sovinz P, Krammer B, et al. Feasibility and toxicity of intrathecal liposomal cytarabine in 5 children and young adults with refractory neoplastic meningitis. J Pediatr Hematol Oncol. 2007; 29(4): 222–226.
- Parasole R, Menna G, Marra N, et al. Efficacy and safety of intrathecal liposomal cytarabine for the treatment of meningeal relapse in acute lymphoblastic leukemia: experience of two pediatric institutions. Leuk Lymphoma. 2008; 49(8): 1553–1559.
- Peyrl A, Sauermann R, Traunmueller F, et al. Pharmacokinetics and safety of intrathecal liposomal cytarabine in children aged <3 years. Clin Pharmacokinet. 2009; 48(4): 265–271.
- Jabbour E, O'Brien S, Kantarjian H, et al. Neurologic complications associated with intrathecal liposomal cytarabine given prophylactically in combination with high-dose methotrexate and cytarabine to patients with acute lymphocytic leukemia. Blood. 2007; 109(8): 3214–3218.
- Jurczak W, Kroll-Balcerzak R, Giebel S, et al. Liposomal cytarabine in the prophylaxis and treatment of CNS lymphoma: toxicity analysis in a retrospective case series study conducted at Polish Lymphoma Research Group Centers. Med Oncol. 2015; 32(4): 90.
- Valentin A, Troppan K, Pfeilstöcker M, et al. Safety and tolerability of intrathecal liposomal cytarabine as central nervous system prophylaxis in patients with acute lymphoblastic leukemia. Leuk Lymphoma. 2014; 55(8): 1739–1742.
- Gállego Pérez-Larraya J, Palma JA, Carmona-Iragui M, et al. Neurologic complications of intrathecal liposomal cytarabine administered prophylactically to patients with non-Hodgkin lymphoma. J Neurooncol. 2011; 103(3): 603–609.
- Lunskens S, Lammertijn L, Deeren D, et al. Intracranial hypertension following intrathecal administration of liposomal cytarabine. J Neurol. 2011; 258(1): 162–163.
- Butto A, Al-Holou WN, Junck L, et al. Fulminant chemical ventriculomeningitis following intrathecal liposomal cytarabine administration. J Clin Neurosci. 2011; 18(10): 1417–1418.
