Limfocytarne zapalenie opon mózgowo-rdzeniowych w przebiegu dokanałowego leczenia liposomalną cytarabiną u chorego na ostrą białaczkę limfoblastyczną

Abstract

Central nervous system (CNS) involvement at diagnosis of acute lymphoblastic leukemia (ALL) is found in approximately 5% of patients and is a poor prognosis factor. Introduction of prophylactic strategies reduced involvements rate from 30% to 10% at relapse. Prophylactic regimens include: intrathecal chemotherapy (methotrexate, cytarabine [Ara-C], dexamethasone), irradiation of the whole brain, and systemic chemotherapy penetrating to CNS. Liposomal Ara-C is a prolonged-release formulation of Ara-C dedicated to intrathecal use. Its half-time is about 2 weeks. It has been used in prophylaxis and treatment regimens. Clinical trials proved its better efficacy and patients’ quality of life than its standard formulation. However, in comparison with classic triple intrathe¬cal therapy, using liposomal Ara-C may have higher risk of neurotoxicity. In the paper we report a case of 47-years-old patient with pre-T ALL who after third injection of liposomal Ara-C developed a symptomless lymphocytic meningitis with the maximal cytosis in cerebrospinal fluid of 1600 cells/μl. The review of the literature on neurotoxicity of liposomal Ara-C is hereby presented.