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Pediatric Transplants

Use of intrathecal chemoprophylaxis in children after SCT and the risk of central nervous system relapse

Bone Marrow Transplantation volume 46, pages 372–378 (2011)Cite this article

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Abstract

Conflicting conclusions can be drawn from the available data concerning antileukemic efficacy and risks of intrathecal (i.t.) chemoprophylaxis to children after hematopoietic SCT (HSCT). To address this, we enrolled six transplantation centers with similar treatment and patient material. Of the 397 children included, 136 patients had received post-HSCT i.t. treatment (i.t. group) and 261 had not (non-i.t. group). The two groups were, apart from the i.t. therapy given or not given, at equal risk of post-HSCT central nervous system (CNS) relapse, which was the primary endpoint studied. Isolated CNS relapses were observed in 2 (1.5%) patients from the i.t. group and 2 (1%) from the non-i.t. group. Combined relapses, including CNS, involved 4 (3%) patients from the i.t. group and 6 (2%) from the non-i.t. group. Overall survival and the occurrence of neurological side effects did not differ significantly between the groups. There was no statistically significant difference in the incidence of isolated or mixed CNS relapses between the two groups, suggesting little or no benefit from i.t. therapy post-HSCT in children.

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Acknowledgements

We thank Marianne Alverstrand for invaluable technical assistance and Jan Kowalski for excellent statistical assistance. This work was supported by Mary Béve Foundation for Pediatric Cancer Research, The Swedish Children Cancer Foundation, The Samariten Foundation and a Government Public Health Grant (ALF).

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Authors and Affiliations

  1. Department of Clinical Science, Intervention and Technology, Astrid Lindgren Children's Hospital, Karolinska University Hospital-Huddinge, CLINTEC, Karolinska Institutet, Stockholm, Sweden

    J Rubin, J Winiarski & B Gustafsson

  2. Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu, Finland

    K Vettenranta & J Vettenranta

  3. Department of Hematology, University Children's Hospital, Utrecht, The Netherlands

    M Bierings

  4. Queen Silvias Children's Hospital, Gothenburg, Sweden

    J Abrahamsson

  5. Lund University Hospital, Lund, Sweden

    A N Békássy

  6. Department of Pediatrics, University Hospital, Lund, Sweden

    Y Håkansson

  7. Department of Pediatrics, Uppsala University Children's Hospital, Uppsala, Sweden

    B-M Frost & J Arvidson

  8. Karolinska Institutet, Stockholm, Sweden

    C Spendilow

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  1. J Rubin
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  2. K Vettenranta
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Correspondence to B Gustafsson.

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Rubin, J., Vettenranta, K., Vettenranta, J. et al. Use of intrathecal chemoprophylaxis in children after SCT and the risk of central nervous system relapse. Bone Marrow Transplant 46, 372–378 (2011). https://doi.org/10.1038/bmt.2010.121

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  • DOI: https://doi.org/10.1038/bmt.2010.121

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