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Dexamethasone FREE

Anna Mitus, MD
[+] Author Affiliations

Received for publication May 15, 1968.

Reprint requests to Children's Cancer Research Foundation, Inc., 35 Binney St, Boston 02115.


Am J Dis Child. 1969;117(3):307-312. doi:10.1001/archpedi.1969.02100030309009.
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IN SPITE of the progress in treatment of childhood leukemia, the control of meningeal leukemia remains a problem. The blood brain barrier prevents the penetration of the antileukemic drugs into the central nervous system (CNS)1-5 and the anatomical geography of the cerebral gyri renders leukemic cells inaccessible to drugs injected into the subarachnoid space. When the antileukemic drug is given intrathecally, it often fails to eradicate malignant cells completely, as shown by the frequent reappearance of blasts in the cerebrospinal fluid (CSF) and by the persistence at postmortem examination of leukemic infiltrate in the CNS.6

The clinical picture of meningeal leukemia varies in the extent and severity of the neurological symptoms and signs. Headache, nausea and vomiting, drowsiness, and irritability are the most frequent symptoms; papilledema, cranial nerve palsies, and separation of the cranial sutures are the most common signs. Headache when present can be of an extreme

REFERENCES

Rall, D.P., and Zubrod, C.G.:  Mechanism of Drug Absorption and Excretion , Ann Rev Pharmacol 2:109-128 1962;.
Whiteside, J.A., et al:  Intrathecal Amethopterin in Neurological Manifestations of Leukemia , Arch Intern Med 101:279-285 ( (Feb) ) 1958;.
Wollner, N.; Murphy, M.L.; and Gordon, C.S.:  A Study of Intrathecal Methotrexate , Proc Amer Assoc Cancer Res 3:74 ( (March) ) 1959;.
Hamilton, L., and Elion, G.B.:  The Fate of 6-Mercaptopurine in Man , Ann NY Acad Sci 60: 304-314 ( (Dec 6) ) 1954;.
Rall, D.P.:  Experimental Studies of the Blood Brain Barrier , Cancer Res 25:1572-1577 ( (Oct) ) 1965;.
Thomas, L.B.:  Pathology of Leukemia in the Brain of Meninges , Cancer Res 25:1555-1563 ( (Oct) ) 1965;.
Prados, M.; Strowger, B.; and Feindel, W.:  Studies on Cerebral Edema , Arch Neurol Psychiat 54:290-300 ( (Oct) ) 1945;.
Long, D.M.; Hartman, F.I.; and French, L.A.:  The Response of Experimental Cerebral Edema to Glucosteroid Administration , J Neurosurg 28:843-853 ( (May) ) 1966;.
Taylor, J.M., et al:  Prevention of Experimental Cerebral Edema by Corticosteroids , Neurology 15: 667-674 ( (July) ) 1965;.
Ingraham, F.D.; Matson, D.D.; and McLaurin, R.L.:  Cortisone and ACTH as Adjunct to Surgery of Craniopharyngiomas , New Eng J Med 246:568-571 ( (April 10) ) 1952;.
Galicich, J.H.; French, L.A.; and Melby, J.C.:  Use of Dexamethasone in the Treatment of Cerebral Edema Associated With Brain Tumors , J Lancet 81:46-53 ( (Feb) ) 1961;.
Matson, D.D.:  Treatment of Cerebral Swelling , New Eng J Med 272:626-628 ( (March 25) ) 1965;.
Grenell, R.G., and McCawley, E.L.:  Central Nervous System Resistance , J Neurosurg 4:508-518 ( (Nov) ) 1947;.
Grenell, R.G., and Mendelsohn, T.:  Adrenal Steroids and Cerebrovascular Permeability-Preliminary Note, Bulletin of the School of Medicine , University of Maryland 39:56-58 ( (April) ) 1954;.
Sansone, G.:  Pathomorphosis of Acute Infantile Leukemia Treated With Modern Therapeutic Agents "Meningoleukaemia and Frölich's Obesity," Ann Paediat 183:33-42 ( (July) ) 1954;.
Hyman, C.B., et al:  Central Nervous System Involvement by Leukemia in Children: I. Relationship to Systemic Leukemia and Description of Clinical and Laboratory Manifestations , Blood 25: 1-12 ( (Jan) ) 1965;.
Rieselbach, R.E., et al:  Intrathecal Aminopterin Therapy of Meningeal Leukemia , Arch Intern Med 111:132-142 ( (May) ) 1963;.
Evans, A.E., and Craig, M.:  Central Nervous System Involvement in Children With Acute Leukemia , Cancer 17:256-258 ( (Feb) ) 1963;.
Shaw, R.K., et al:  Meningeal Leukemia , Neurology 10:823-833 ( (Sept) ) 1960;.

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References

Rall, D.P., and Zubrod, C.G.:  Mechanism of Drug Absorption and Excretion , Ann Rev Pharmacol 2:109-128 1962;.
Whiteside, J.A., et al:  Intrathecal Amethopterin in Neurological Manifestations of Leukemia , Arch Intern Med 101:279-285 ( (Feb) ) 1958;.
Wollner, N.; Murphy, M.L.; and Gordon, C.S.:  A Study of Intrathecal Methotrexate , Proc Amer Assoc Cancer Res 3:74 ( (March) ) 1959;.
Hamilton, L., and Elion, G.B.:  The Fate of 6-Mercaptopurine in Man , Ann NY Acad Sci 60: 304-314 ( (Dec 6) ) 1954;.
Rall, D.P.:  Experimental Studies of the Blood Brain Barrier , Cancer Res 25:1572-1577 ( (Oct) ) 1965;.
Thomas, L.B.:  Pathology of Leukemia in the Brain of Meninges , Cancer Res 25:1555-1563 ( (Oct) ) 1965;.
Prados, M.; Strowger, B.; and Feindel, W.:  Studies on Cerebral Edema , Arch Neurol Psychiat 54:290-300 ( (Oct) ) 1945;.
Long, D.M.; Hartman, F.I.; and French, L.A.:  The Response of Experimental Cerebral Edema to Glucosteroid Administration , J Neurosurg 28:843-853 ( (May) ) 1966;.
Taylor, J.M., et al:  Prevention of Experimental Cerebral Edema by Corticosteroids , Neurology 15: 667-674 ( (July) ) 1965;.
Ingraham, F.D.; Matson, D.D.; and McLaurin, R.L.:  Cortisone and ACTH as Adjunct to Surgery of Craniopharyngiomas , New Eng J Med 246:568-571 ( (April 10) ) 1952;.
Galicich, J.H.; French, L.A.; and Melby, J.C.:  Use of Dexamethasone in the Treatment of Cerebral Edema Associated With Brain Tumors , J Lancet 81:46-53 ( (Feb) ) 1961;.
Matson, D.D.:  Treatment of Cerebral Swelling , New Eng J Med 272:626-628 ( (March 25) ) 1965;.
Grenell, R.G., and McCawley, E.L.:  Central Nervous System Resistance , J Neurosurg 4:508-518 ( (Nov) ) 1947;.
Grenell, R.G., and Mendelsohn, T.:  Adrenal Steroids and Cerebrovascular Permeability-Preliminary Note, Bulletin of the School of Medicine , University of Maryland 39:56-58 ( (April) ) 1954;.
Sansone, G.:  Pathomorphosis of Acute Infantile Leukemia Treated With Modern Therapeutic Agents "Meningoleukaemia and Frölich's Obesity," Ann Paediat 183:33-42 ( (July) ) 1954;.
Hyman, C.B., et al:  Central Nervous System Involvement by Leukemia in Children: I. Relationship to Systemic Leukemia and Description of Clinical and Laboratory Manifestations , Blood 25: 1-12 ( (Jan) ) 1965;.
Rieselbach, R.E., et al:  Intrathecal Aminopterin Therapy of Meningeal Leukemia , Arch Intern Med 111:132-142 ( (May) ) 1963;.
Evans, A.E., and Craig, M.:  Central Nervous System Involvement in Children With Acute Leukemia , Cancer 17:256-258 ( (Feb) ) 1963;.
Shaw, R.K., et al:  Meningeal Leukemia , Neurology 10:823-833 ( (Sept) ) 1960;.

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