TY - JOUR
T1 - Central Nervous System Prophylaxis and Treatment in Acute Leukemias
AU - Wu, Susan Y.
AU - Short, Nicholas J.
AU - Nasr, Lewis
AU - Dabaja, Bouthaina S.
AU - Fang, Penny Q.
N1 - Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Improvements in systemic therapy in the treatment of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) have improved patient outcomes and reduced the incidence of CNS relapse. However, management of patients with CNS disease remains challenging, and relapses in the CNS can be difficult to salvage. In addition to treatment with CNS-penetrant systemic therapy (high-dose methotrexate and cytarabine), intrathecal prophylaxis is indicated in all patients with ALL, however is not uniformly administered in patients with AML without high-risk features. There is a limited role for radiation treatment in CNS prophylaxis; however, radiation should be considered for consolidative treatment in patients with CNS disease, or as an option for palliation of symptoms. Re-examining the role of established treatment paradigms and investigating the role of radiation as bridging therapy in the era of cellular therapy, particularly in chemotherapy refractory patients, is warranted.
AB - Improvements in systemic therapy in the treatment of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) have improved patient outcomes and reduced the incidence of CNS relapse. However, management of patients with CNS disease remains challenging, and relapses in the CNS can be difficult to salvage. In addition to treatment with CNS-penetrant systemic therapy (high-dose methotrexate and cytarabine), intrathecal prophylaxis is indicated in all patients with ALL, however is not uniformly administered in patients with AML without high-risk features. There is a limited role for radiation treatment in CNS prophylaxis; however, radiation should be considered for consolidative treatment in patients with CNS disease, or as an option for palliation of symptoms. Re-examining the role of established treatment paradigms and investigating the role of radiation as bridging therapy in the era of cellular therapy, particularly in chemotherapy refractory patients, is warranted.
KW - CAR-T
KW - CNS leukemia
KW - Craniospinal radiation
KW - Cytarabine
KW - High-dose methotrexate
KW - Intrathecal chemotherapy
KW - Leukemia
KW - Stem cell transplant
KW - Whole brain radiation
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U2 - 10.1007/s11864-022-01032-5
DO - 10.1007/s11864-022-01032-5
M3 - Article
C2 - 36510037
AN - SCOPUS:85143659769
SN - 1527-2729
VL - 23
SP - 1829
EP - 1844
JO - Current treatment options in oncology
JF - Current treatment options in oncology
IS - 12
ER -