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Ommaya reservoir use in pediatric ALL and NHL: a review at St. Jude Children’s Research Hospital

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Cancer Chemotherapy and Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

The intraventricular route of chemotherapy administration, via an Ommaya Reservoir (OmR) improves drug distribution in the central nervous system (CNS) compared to the more commonly used intrathecal administration. We retrospectively reviewed our experience with intraventricular chemotherapy, focused on methotrexate, in patients with Acute Lymphoblastic Leukemia (ALL) and Non-Hodgkin Lymphoma (NHL).

Methods

Twenty-four patients (aged 7 days – 22.2 years) with 26 OmR placements were identified for a total of 25,009 OmR days between 1990 and 2019. Methotrexate cerebrospinal fluid (CSF) concentrations (n = 124) were analyzed from 59 courses of OmR therapy in 15 patients. Twenty-one courses involved methotrexate dosing on day 0 only, whereas 38 courses involved booster dosing on days 1, 2, or both. We simulated the time CSF methotrexate concentrations remained > 1 µM for 3 days given various dosing regimens.

Results

CSF methotrexate exposure was higher in those who concurrently received systemic methotrexate than via OmR alone (p < 10− 7). Our simulations showed that current intraventricular methotrexate boosting strategy for patients ≥ 3 years of age maintained CSF methotrexate concentrations ≥ 1 µM for 72 h 40% of the time. Alternatively, other boosting strategies were predicted to achieve CSF methotrexate concentrations ≥ 1 µM for 72 h between 46 and 72% of the time.

Conclusions

OmR were able to be safely placed and administer intraventricular methotrexate with and without boost doses in patients from 7 days to 22 years old. Boosting strategies are predicted to increase CSF methotrexate concentrations ≥ 1 µM for 72 h.

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Acknowledgements

Supported in part by Cancer Center Core Grant NIH P30 CA 21765 core grant and by American Lebanese Syrian Associated Charities (ALSAC).

Author information

Authors and Affiliations

  1. Department of Pharmacy Services, University of Kentucky Healthcare, Lexington, KY, USA

    Alyssa Gaietto

  2. Department of Pharmacy and Pharmaceutical Services, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail stop 150, Memphis, TN, 38105, USA

    John C Panetta, Mary V Relling & Hope D Swanson

  3. Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Jennifer L Pauley

  4. Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Raul Ribeiro, Matthew J Ehrhardt, Ching-Hon Pui & Hiroto Inaba

Authors
  1. Alyssa Gaietto
  2. John C Panetta
  3. Jennifer L Pauley
  4. Mary V Relling
  5. Raul Ribeiro
  6. Matthew J Ehrhardt
  7. Ching-Hon Pui
  8. Hiroto Inaba
  9. Hope D Swanson

Contributions

A.G., H.D.S, J.C.P. performed research; A.G., H.D.S, J.C.P. analyzed data; A.G., H.D.S, J.C.P. J.L.P, M.V.R., R.R., M.J.E, C.H.P, H.I. designed the study; and A.G., H.D.S, J.C.P. J.L.P, M.V.R., R.R., M.J.E, C.H.P, H.I. wrote the manuscript.

Corresponding author

Correspondence toHope D Swanson.

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Gaietto, A., Panetta, J.C., Pauley, J.L.et al. Ommaya reservoir use in pediatric ALL and NHL: a review at St. Jude Children’s Research Hospital.Cancer Chemother Pharmacol93, 617–625 (2024). https://doi.org/10.1007/s00280-024-04653-9

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