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April 3, 1978

Prolonged Meningeal LeukemiaOccurrence During Hematologic Remission of Acute Myeloblastic Leukemia

Author Affiliations

From the Division of Hematology, Queens Hospital Center Affiliation of the Long Island Jewish-Hillside Medical Center, Jamaica, NY (Drs Zachariah, Grünwald, and Rosner); and the Department of Medicine, Health Sciences Center, State University of New York, Stony Brook (Drs Grünwald and Rosner).

JAMA. 1978;239(14):1423-1424. doi:10.1001/jama.1978.03280410065026

MENINGEAL leukemia accounts for initial relapses in many patients with acute lymphocytic leukemia.1 Systemically administered chemotherapy does not penetrate the blood-brain barrier, and leukemic cells in this sanctuary can multiply uncontrolled. With the introduction of prophylactic cranial irradiation and the intrathecal administration of methotrexate and other cytotoxic agents, a definite reduction of meningeal leukemia has occurred.2

In cases of acute myelocytic leukemia, meningeal leukemia occurs less frequently. Weil and co-workers,3 in a study of 836 cases of acute myelocytic leukemia, found meningeal leukemia in only 48 instances (5.7%). Seligman et al4 also noted a similar incidence in their review. Because of this low incidence, prophylactic treatment for meningeal leukemia is not widely used in acute myelocytic leukemia. The most frequent form of relapse in this type of leukemia after successful remission induction is hematologic. Improved remission induction due to better chemotherapy and immunotherapy5 and longer