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Cerebrospinal fluid lactic dehydrogenase activity in children with acute lymphoblastic leukemia treated for cranial
Insights
Total lactic dehydrogenase (TLDH) activity in cerebrospinal fluid (CSF) may indicate brain damage in children with acute lymphoblastic leukemia (ALL) undergoing cranial prophylaxis. Combined prophylaxis showed higher TLDH levels, suggesting increased toxicity.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Biochemistry
Background:
- Cranial prophylaxis is used to prevent central nervous system relapse in acute lymphoblastic leukemia (ALL).
- Potential neurotoxicity of prophylactic treatments is a significant concern in pediatric ALL patients.
- Biochemical markers are needed to assess treatment-related brain damage.
Purpose of the Study:
- To evaluate Total Lactic Dehydrogenase (TLDH) activity in cerebrospinal fluid (CSF) as a biochemical marker for brain damage.
- To compare the neurotoxicity of combined cranial prophylaxis versus radiotherapy or intrathecal methotrexate alone in ALL patients.
Main Methods:
- Prospective study measuring TLDH activity in CSF of pediatric ALL patients.
- Collected samples before and after different prophylactic regimens: combined (radiotherapy + intrathecal methotrexate), radiotherapy alone, and intrathecal methotrexate alone.
- Statistical analysis to compare TLDH levels between groups.
Main Results:
- TLDH activity in CSF was significantly higher in the combined prophylaxis group compared to pre-prophylaxis levels (p < 0.05).
- Insignificant elevations in TLDH activity were observed in the radiotherapy alone and intrathecal methotrexate alone groups (p > 0.05).
Conclusions:
- Combined cranial prophylaxis (radiotherapy and intrathecal methotrexate) appears to be more neurotoxic than either modality used alone in pediatric ALL.
- TLDH activity in CSF shows potential as a biochemical marker for assessing neurotoxicity from cranial prophylaxis.
Abstract:
Total lactic dehydrogenase (TLDH) activity in cerebrospinal fluid (CSF) has been prospectively studied in order to determine whether it could be a biochemical marker for brain damage due to cranial prophylaxis in children with acute lymphoblastic leukemia (ALL). TLDH activity has been measured in 15 patients before prophylaxis, in 15 patients after the prophylaxis which consisted of cranial radiotherapy (2400 rads) and intrathecal methotrexate (0.5 mg/kg-dose, 5 doses), in 8 patients after radiotherapy alone (2400 rads) and in 9 patients after intrathecal methotrexate (0.5 mg/kg-dose, 5 doses) alone. TLDH activity in CSF of combined prophylaxis group has been found to be higher than the ones before study (p less than 0.05). There were insignificant elevations of TLDH activity in the other two groups (p greater than 0.05; p greater than 0.05). This result indicated combined cranial prophylaxis seemed to be more toxic than the other prophylaxis regimens when they were used alone.