Intrathecal Amethopterin in Neurological Manifestations of Leukemia

The difficulty in managing acute leukemia in children is enhanced by the occurrence of neurological manifestations. It is especially true when this component of the disease occurs, as it may, during a period with few positive physical findings and a bone marrow in remission. Prior to the use of current chemotherapeutic agents, leukemic-cell invasion of the parenchyma of the brain, meninges, and cranial nerves was noted frequently at postmortem examination.1,2At times this involvement was closely correlated with clinical symptoms which presented early in the course of the disease. At present the leukemic child who develops central nervous system manifestations often does so while being given maintenance antileukemic therapy months after the initial diagnosis is made. This suggests that these current agents are only partially effective against the leukemic cell in the central nervous system in the conventional dosage and route of administration. To supplement the incomplete response of