The Use of Ommaya Reservoirs to Deliver Central Nervous System-Directed Chemotherapy in Childhood Acute Lymphoblastic Leukaemia.
Ruairi WilsonCaroline OsborneChristina HalseyPublished in: Paediatric drugs (2018)
Prophylactic eradication of central nervous system (CNS) leukaemia is the current standard of care in treating childhood acute lymphoblastic leukaemia (ALL). This is conventionally achieved through regular lumbar punctures with intrathecal injections of methotrexate into the cerebrospinal fluid (CSF). Ommaya reservoirs are subcutaneous implantable devices that provide a secure route of drug delivery into the CSF via an intraventricular catheter. They are an important alternative in cases where intrathecal injection via lumbar puncture is difficult. Among UK Paediatric Principal Treatment Centres for ALL we found considerable variation in methotrexate dosing when using an Ommaya reservoir. We review the current safety and theoretical considerations when using Ommaya reservoirs and evidence for methotrexate dose adjustments via this route. We conclude by summarising the pragmatic consensus decision to use 50% of the conventional intrathecal dose of methotrexate when it is administered via Ommaya reservoir in front-line ALL therapy.
Keyphrases
- cerebrospinal fluid
- high dose
- ultrasound guided
- liver failure
- drug delivery
- minimally invasive
- respiratory failure
- healthcare
- drug induced
- aortic dissection
- emergency department
- palliative care
- intensive care unit
- stem cells
- low dose
- squamous cell carcinoma
- randomized controlled trial
- clinical trial
- study protocol
- pain management
- cancer therapy
- young adults
- platelet rich plasma
- locally advanced
- rectal cancer