Sanctuary sites in Acute Lymphoblastic Leukemia
- Sanctuary sites in acute lymphoblastic leukemia refers to areas where the leukemia cells are protected from the systemic chemotherapy
- CNS and testis are the important sanctuary sites for ALL
- These leukemic cells can produce relapse later and hence should be taken care of
CNS prevention therapy for Acute Lymphoblastic Leukemia:
- As the chemotherapeutic agents do not cross the blood brain barrier, intrathecal methotrexate and cranial irradiation is used to kill leukemia cells residing in the CNS
- This results in increased survival rates but have also causes neurotoxicity and increased risk for CNS malignancies
- To decreased neurotoxicity, experts now recommend a lower dose of CNS irradiation (1800cGy) with intrathecal methotrexate
- Also triple regimen intrathecal chemotherapy (methotrexate, hydrocortisone and cytarabine) without CNS irradiation is also considered
