Practice of central nervous system prophylaxis and treatment in acute leukemias in Spain. Prospective registry study

ABSTRACT

BACKGROUND AND OBJECTIVE: Central nervous system (CNS) involvement in patients diagnosed with acute leukemias(AL) is an uncommon complication with poor prognosis. The indication and the schedules of prophylaxisand treatment of CNS involvement in AL are not homogenous among countries and within the same country.The aim of this prospective longitudinal study was to analyze and report the practice of CNS prophylaxis andtreatment in patients with AL in Spain.PATIENTS AND METHOD: Prospective study conducted from June 2005 to June 2006. Adult patients ( 18 yr.)diagnosed with AL who received CNS prophylaxis or treatment were consecutively included through online registration.RESULTS: 265 patients from 32 hospitals were included. Mean (standard deviation) age was 44 (16) yr. and133 (50%) were males. For acute lymphoblastic leukemia patients (n = 158), CNS therapy was given to 12cases (10 at diagnosis and 2 at relapse) and consisted of triple intrathecal therapy (TIT, methotrexate, cytarabineand hydrocortisone) in 11 and liposomal depot cytarabine in one. CNS prophylaxis (n = 146) consistedof TIT in 135 cases, intrathecal methotrexate in 7, intrathecal cytarabine in 2 and intrathecal liposomal depotcytarabine in 2. No cranial irradiation either for prophylaxis or therapy was given in any case. In acute myeloblasticleukemia patients (n = 107), CNS therapy was administered to 17 cases (9 at diagnosis and 8 at relapse).Intrathecal therapy consisted of TIT in 11, intrathecal liposomal depot cytarabine in 5 and intrathecalcytarabine in one. One patient also received craniospinal irradiation. CNS prophylaxis (n = 90) consisted ofTIT in 68 cases and intrathecal methotrexate in 22.CONCLUSIONS: In Spain, the patterns of CNS prophylaxis and therapy for AL are homogeneous. TIT was the mostfrequent schedule for CNS prophylaxis and therapy. The lack of use of cranial or craniospinal irradiation andthe administration of new drugs (i.e. liposomal depot cytarabine) for CNS therapy and prophylaxis is of note