Reduced Central Nervous System Leukemia by the Prophylaxis with Intermittent Intrathecal Methotrexate and Prednisolone in Adults with Acute Leukemia

Abstract

In adults with acute leukemia, the central nervous system (CNS) prophylaxis with intrathecal methotrexate (MTX) and prednisolone (PSL) reduced the incidence of the CNS leukemia.
The incidence of the CNS leukemia in patients with CNS prophylaxis which was done two to three times just after complete remission was 35% (7/20) compared to 24% (8/33) in patients without CNS prophylaxis. No difference was observed in these two groups (p<0.10). This result prompted us to try the intermittent CNS prophylaxis at 1. 3. 6. 10. 15 mo after the consolidation therapy and every 6 mo. thereafter when the intensification therapy was performed. Nineteen patients, who achieved complete remission and entered into this intermittent prophylactic treatment program between January 1980 and March 1983, were given 10 mg of MTX and 20 mg of PSL intrathecally as designed and observed for 19 to 58 mo. and none of them developed CNS leukemia in remission.
The intrathecal administration of MTX and PSL is easy to perform and there has been no adverse reaction in our series. We conclude that the intermittend CNS prophylaxis with MTX and PSL is of benefit in preventing CNS leukemia in adults with acute leukemia.