The Use of Ommaya Reservoirs to Deliver Central Nervous System-Directed Chemotherapy in Childhood Acute Lymphoblastic Leukaemia

Paediatric Drugs
Ruairi WilsonChristina Halsey

Abstract

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.

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Citations

Feb 21, 2019·Journal of Cellular and Molecular Medicine·Yann CormeraisVincent Picco
Apr 30, 2019·Scandinavian Journal of Caring Sciences·Terence V McCannDan I Lubman
Nov 2, 2019·Journal of Neuroscience Methods·Ulrike ErbMichael Karremann
Jul 30, 2021·Blood·Christina Halsey, Gabriele Escherich
Jan 21, 2020·The Lancet Child & Adolescent Health·David A WalkerChristina Halsey
Nov 28, 2021·Pediatrics International : Official Journal of the Japan Pediatric Society·Yurika KurokoDaisuke Hasegawa

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