e19579 Background: Treatment of meningeosis neoplastica remains challenging due to advanced systematic disease and limited treatment options including a high treatment burden. Liposomal Cytarabine (DepoCyte) is a slow-release formulation of cytarabine that maintains cytotoxic concentrations in the Cerebrospinal fluid (CSF) for >14 days following a single injection. This two week interval has potential benefit due to reduced interventions especially in palliative settings. Methods: We reviewed all patients at our institution treated with liposomal cytarabine (LC) between 3/2004 and 9/2011.The data included tumor type, ICF-cell-count, neurologic disorders due to meningeal affection and time interval from intrathecal therapy to progression and to death of the patient.Assessment for meningeosis neoplastica included neurological examination, CSF assessment and brain MR imaging. LC was administered intralumbar at 50 mg every 2-weeks until progression or appearance of severe side effects. Results: To date 51 adult patients eligible for safety evaluation (48 pts. for efficacy evaluation) (median age 61 y [range 23 - 81 y]) were treated with LC. 72.5% of the included patients had lymphoma, 5.9% breast cancer and 21.6% other solid malignancies. Concurrent systemic chemotherapy was given in 82% of the patients. A total of 160 doses were administered (mean 2.9, range 1- 13). The most frequent side effects were mucositis (21.6%), elevated body temperature (15.7%), backpain (9.8%) and nausea/vomiting (7.8/5.9%). In two lymphoma patients with long term use of LC (13/ 4 applications) cauda equina syndroms appeared. In 61.9% of patients a reduction of neurological symptoms could be achieved; 53% of the patients attained a cytological response in CSF. Median overall survival was 20 months. Conclusions: The obtained results are comparable to those previously reported for methotrexate given 3 times a week. Thus our trial indicates that the 14-day dosing interval is on one hand effective to decrease neurological symptoms caused by meningeosis neoplastica with a favourable safety profile and on the other hand is less burdensome for the patients due to reduced manipulation and treatment burden respectively.
Detection of Meningeosis neoplastica by real-time quantitation of telomerase activity
