Evaluating the Role of Intrathecal Chemotherapy in CNS Prophylaxis for Pediatric Leukemias: A Retrospective Study

Sumera Abdul  Karim; Sumbal  Abbas; Syeda Tehreem Zahra  Gillani; Syeda Urooj Fatima  Gillani; Madiha  Jameel; Najma  Shaheen

doi:10.54112/bcsrj.v6i5.1889

Authors

Sumera Abdul Karim Department of Pediatric Oncology and Hematology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
Sumbal Abbas Department of Pediatric Oncology and Hematology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
Syeda Tehreem Zahra Gillani Department of Pediatric Oncology and Hematology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
Syeda Urooj Fatima Gillani Department of Pediatric Oncology and Hematology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
Madiha Jameel Department of Pediatric Oncology and Hematology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
Najma Shaheen Department of Pediatric Oncology and Hematology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i5.1889

Keywords:

Pediatric leukemia, CNS prophylaxis, intrathecal chemotherapy, CNS relapse, acute lymphoblastic leukemia, AML

Abstract

The central nervous system (CNS) is a sanctuary site for leukemic cells in pediatric acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML), necessitating targeted prophylaxis. Objective: To evaluate the effect of IT chemotherapy intensity on CNS relapse-free survival (CNS-RFS) in pediatric leukemia patients. Methods: This retrospective observational study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center from 2023 to 2024. A total of 150 pediatric patients (118 ALL, 32 AML) were included in the study. Patients were categorized as receiving full-intensity (≥90% of planned IT doses) or reduced-intensity (<90%) CNS prophylaxis. Results: Of the cohort, 108 patients (72.0%) received full-intensity IT chemotherapy and 42 (28.0%) received reduced-intensity. Over a median follow-up of 48 months, CNS relapse occurred in 4 patients (3.7%) in the full-intensity group versus 10 patients (23.8%) in the reduced-intensity group (p < 0.001). Five-year CNS-RFS was significantly higher with full-intensity prophylaxis (96.0% vs. 71.4%, p < 0.001). Multivariable analysis showed reduced-intensity IT was independently associated with increased CNS relapse risk (HR 4.85; 95% CI: 1.78–13.21; p = 0.002). Neurotoxicity occurred in 7.3% of patients, mostly reversible, and procedural complications occurred in 5.3%, with no permanent deficits. Conclusion: Full-intensity IT chemotherapy is strongly associated with lower CNS relapse rates and improved CNS-RFS in pediatric leukemia, particularly in high-risk subgroups. Minimizing treatment interruptions and addressing logistical barriers are essential to maintain optimal CNS prophylaxis, especially in the era of reduced cranial irradiation.

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