Excessive spinal cord and CNS toxicity (tox) in Burkitt leukemia/lymphoma (BL) therapy in childhood (Meeting abstract).

Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.

Excessive spinal cord and CNS toxicity (tox) in Burkitt leukemia/lymphoma (BL) therapy in childhood (Meeting abstract).

Proc Annu Meet Am Soc Clin Oncol; 12:A1318 1993. Unique Identifier : AIDSLINE ICDB/94695717
Priest J; Moertel C; Toogood I; Nieder M; Morse M; Frierdich S; Children's Hosp. of St. Paul, MN 55102

Abstract: CNS BL at diagnosis (dx) or relapse is a frequent cause of treatment (rx) failure in BL, necessitating aggressive prophylactic/therapeutic CNS rx. 8 children pts are reported with severe CNS and spinal cord toxicity following BL rx: 2 deaths with brain and spinal cord necrosis, 2 permanent paraplegia, 4 ambulatory spastic paraparesis; 3 females, 5 males; ages 4-16 yr. 7/8 were new dx BL; 1 was primary CNS lymphoma. All pts received systemic rx before CNS tox, including cyclophos, vincristine, doxo, steroids, L'asp, low-dose Ara-C; 1 pt also received thiotepa and HD Mtx. CNS status and rx prior to tox are summarized in a table. 1 pt had extrinsic cord compression at dx, which markedly improved with remission; cord tox occurred in XRT field 16 wk later. 1 pt had CNS BL and cord/brain necrosis at autopsy; all other pts were BL disease-free at tox and later. Analyzing these with literature cases of cord tox, we conclude that (1) dose intensity of CNS rx causes CNS tox in BL pts; (2) IT Ara-C is probably most toxic, especially doses greater than 70 mg/dose, greater than 140 mg/wk, or greater than 420 mg/mo, in this age group; (3) IT Mtx may contribute; (4) IT hydrocortisone is not protective; (5) prior or concurrent XRT, HD Mtx, and HD Ara-C may add to tox; (6) HIV may predispose to tox.

Keywords: Adolescence Antineoplastic Agents/*ADVERSE EFFECTS/THERAPEUTIC USE Antineoplastic Agents, Combined/*ADVERSE EFFECTS/THERAPEUTIC USE Brain/*DRUG EFFECTS/PATHOLOGY Brain Diseases/*CHEMICALLY INDUCED Burkitt's Lymphoma/*DRUG THERAPY/*RADIOTHERAPY Child Child, Preschool Female Human Male Necrosis Paraplegia/*CHEMICALLY INDUCED Spinal Cord/*DRUG EFFECTS/PATHOLOGY ABSTRACT
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M9420821

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