Abstract
Children with acute lymphocytic leukemia were examined for intracranlal calcifications with computerized tomography and skull x-rays. Of 39 patients in continuous complete remission for 6 months to 6 years, 10 had 1 or more subcortical calcifications. All patients had received similar induction chemotherapy (prednisone and vincristine ± adriamycin) and CNS prophylaxis (whole-brain irradiation, 2400r., and 5 Injections of intrathecal MTX). Maintenance chemotherapy varied. Significant association between presence of intracranial calcification and total cumulative dose of systemically administered MTX was found. Among age-matched children treated for 21 to 32 months, 1/5 receiving ≤ 4.5 gm. MTX had calcification, whereas 6/7 receiving > 4.5 gm. MTX (most intravenous) developed calcification (p-0.03). Among those treated for 11 to 20 months, 0/5 receiving ≤ 4.5 gm. MTX developed intracranial mineralization, as did 3/7 receiving > 4.5 gm. (p-0.16). Statistical analysis also suggests that ara-C may contribute to risk of brain injury. of the 10 affected patients, 8 had signs of chronic MTX encephalopathy-limp, seizures or perceptual-motor handicap. Controlled prospective studies are needed to broaden these observations and to define the roles of brain irradiation and systemic chemotherapeutic drugs in the development of chronic nonleukemic encephalopathy.
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