Intrathecal chemotherapy in Burkitt's lymphoma

Meningeal involvement with Burkitt lymphoma cells constitutes the most challenging therapeutic problem in the management of Burkitt's tumour. The results of intrathecal chemotherapy with methotrexate or cytosine arabinoside in 55 episodes of malignant pleocytosis in 38 patients with Burkitt's tumour are described. The response was complete in nearly all patients after the administration of either agent. Cerebrospinal fluid (C.S.F.) remissions were more prolonged in patients receiving intrathecal methotrexate or cytosine arabinoside daily for four days as opposed to a 10-day schedule. A controlled randomized trial of "prophylactic" intrathecal chemotherapy in patients without malignant cells in the C.S.F. on admission showed no protective effect against the subsequent development of malignant pleocytosis. Future therapeutic approaches are considered in the light of these results.