Canterbury DHB


CNS disease and intrathecal Chemotherapy

All intrathecal chemotherapy must be given in compliance with the CDHB Intrathecal Chemotherapy Policy. Only consultants or senior trainees currently on the CDHB register may prescribe or administer intrathecal chemotherapy.

An initial lumbar puncture is not scheduled until day 24 unless clinically indicated. If overt CNS disease is present intrathecal methotrexate should be given 1-3 times per week until the blasts are no longer present. If transplant is intended do NOT give CNS irradiation.

Imatinib does not penetrate the CNS. Based on data showing dasatinib penetrates the CNS it could be considered preferable in Ph-positive patients with CNS disease.

High-dose systemic methotrexate is an important component of many ALL protocols. Acetazolamide administration may reduce the fluid retention and renal impairment associated with this therapy, and facilitate clearance. See Ku, M., A. Bazargan and C. Tam (2020). "Addition of low dose acetazolamide as an adjunct in patients undergoing high dose methotrexate is safe and beneficial." Intern Med J 50(3): 357-362.

About this Canterbury DHB document (1656):

Document Owner:

Peter Ganly (see Who's Who)

Last Reviewed:

December 2021

Next Review:

December 2024


Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 1656