Consensus Statements
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Effective central nervous system (CNS) prophylaxis for acute lymphoid leukemia requires systemic and intrathecal-directed therapy, with radiation therapy (RT) considered rarely and on a case-by-case basis for patients with high-risk features.
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For patients with overt CNS leukemia at diagnosis or those who develop CNS leukemia at the onset of disease relapse, RT should be considered, especially when other CNS-directed therapy has failed.
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For patients undergoing allogeneic hematopoietic stem cell transplantation, comprehensive RT to the CNS should be considered for patients with acute lymphoid leukemia or acute myeloid leukemia who have a history of CNS involvement.
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We recommend a minimal interval of 2 weeks between the last intravenous or intrathecal administration of methotrexate or cytarabine and initiation of CNS-directed RT. However, in cases in which urgent RT is necessary because of symptoms, shorter intervals of 48 to 72 hours may be considered.
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The choice of comprehensive (ie, craniospinal irradiation) or limited RT to the CNS should depend on the expected long-term outcomes for each individual patient.
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High suspicion for therapy-related neurotoxicity should always be maintained for heavily pretreated patients who present with CNS-related symptoms.
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The recommended RT dose can vary from 18 to 24 Gy.