Intrathecal chemotherapy

Agents include methotrexate, cytabrine arabinoside, hydrocortisone and liposomal

See carcinomatous meningitis

Central nervous system (CNS) involvement, especially involvement of the cerebrospinal fluid (CSF), is common in several hematological malignancies.

Intrathecal (IT) chemotherapy can be used to manage CSF involvement.

In a study of patients with hematologic diseases with meningeal involvement, the majority of patients were diagnosed with diffuse large B-cell lymphoma (26%) or acute lymphoblastic leukemia/lymphoblastic lymphoma (19%).

After first-line IT chemotherapy, which mainly consisted of methotrexate (MTX) and corticosteroids, CSF complete response (CSF CR) was achieved in 76% of patients. 91% reached CSF CR when including second-line IT-chemotherapy.

Clinical response was documented in 75%.

CNS progression/relapse occurred in 40% of patients with median progression-free survival of 12.2 months.

The median overall survival was 18.3 months; 55% of the patients died during follow-up.

IT MTX, cytarabine, and thiotepa can be administered into the spinal fluid, allowing the drug to reach the spinal cord and brain. 



These agents are rapidly cleared from the CSF, requiring administration two or three times a week. 


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