Back to Search Start Over

Ommaya reservoir use in pediatric ALL and NHL: a review at St. Jude Children's Research Hospital.

Authors :
Gaietto A
Panetta JC
Pauley JL
Relling MV
Ribeiro R
Ehrhardt MJ
Pui CH
Inaba H
Swanson HD
Source :
Cancer chemotherapy and pharmacology [Cancer Chemother Pharmacol] 2024 Jun; Vol. 93 (6), pp. 617-625. Date of Electronic Publication: 2024 Feb 28.
Publication Year :
2024

Abstract

Purpose: The intraventricular route of chemotherapy administration, via an Ommaya Reservoir (OmR) improves drug distribution in the central nervous system (CNS) compared to the more commonly used intrathecal administration. We retrospectively reviewed our experience with intraventricular chemotherapy, focused on methotrexate, in patients with Acute Lymphoblastic Leukemia (ALL) and Non-Hodgkin Lymphoma (NHL).<br />Methods: Twenty-four patients (aged 7 days - 22.2 years) with 26 OmR placements were identified for a total of 25,009 OmR days between 1990 and 2019. Methotrexate cerebrospinal fluid (CSF) concentrations (n = 124) were analyzed from 59 courses of OmR therapy in 15 patients. Twenty-one courses involved methotrexate dosing on day 0 only, whereas 38 courses involved booster dosing on days 1, 2, or both. We simulated the time CSF methotrexate concentrations remained > 1 µM for 3 days given various dosing regimens.<br />Results: CSF methotrexate exposure was higher in those who concurrently received systemic methotrexate than via OmR alone (p < 10 <superscript>- 7</superscript> ). Our simulations showed that current intraventricular methotrexate boosting strategy for patients ≥ 3 years of age maintained CSF methotrexate concentrations ≥ 1 µM for 72 h 40% of the time. Alternatively, other boosting strategies were predicted to achieve CSF methotrexate concentrations ≥ 1 µM for 72 h between 46 and 72% of the time.<br />Conclusions: OmR were able to be safely placed and administer intraventricular methotrexate with and without boost doses in patients from 7 days to 22 years old. Boosting strategies are predicted to increase CSF methotrexate concentrations ≥ 1 µM for 72 h.<br /> (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Details

Language :
English
ISSN :
1432-0843
Volume :
93
Issue :
6
Database :
MEDLINE
Journal :
Cancer chemotherapy and pharmacology
Publication Type :
Academic Journal
Accession number :
38416167
Full Text :
https://doi.org/10.1007/s00280-024-04653-9