One of the prime objectives in the therapy of acute childhood leukemia is to maintain the patient symptom-free and capable of enjoying normal activity. The development of neurologic complications poses a serious threat to this aim.
Leukemia involving the central nervous system may be manifested by symptoms and signs of meningeal irritation and increased intracranial pressure, seizures, and/or cranial nerve palsies. Not infrequently patients who have had no symptoms or signs of central nervous system involvement during life may at necropsy be found to have widespread infiltrative lesions involving the meninges and brain.
Since orally administered antimetabolites apparently do not penetrate the blood-cerebrospinal fluid barrier in sufficient concentrations to prevent or control such complications, therapy in the past has included steroids and irradiation to the skull. The beneficial effects of these modes of therapy may be quite short in duration.1
Recently, Burchenal and co-workers2 described a dramatic beneficial