Topotecan in Treating Young Patients With Neoplastic Meningitis Due to Leukemia, Lymphoma, or Solid Tumors
Brain and Central Nervous System Tumors, Carcinoma of Unknown Primary, Leukemia
About this trial
This is an interventional treatment trial for Brain and Central Nervous System Tumors focused on measuring AIDS-related diffuse large cell lymphoma, AIDS-related diffuse mixed cell lymphoma, AIDS-related diffuse small cleaved cell lymphoma, AIDS-related immunoblastic large cell lymphoma, AIDS-related lymphoblastic lymphoma, AIDS-related peripheral/systemic lymphoma, AIDS-related primary CNS lymphoma, AIDS-related small noncleaved cell lymphoma, HIV-associated Hodgkin lymphoma, stage IV childhood Hodgkin lymphoma, stage IV childhood large cell lymphoma, stage IV childhood lymphoblastic lymphoma, stage IV childhood small noncleaved cell lymphoma, primary central nervous system non-Hodgkin lymphoma, primary central nervous system Hodgkin lymphoma, recurrent childhood acute lymphoblastic leukemia, recurrent childhood acute myeloid leukemia, unspecified childhood solid tumor, protocol specific, childhood grade I meningioma, childhood grade II meningioma, childhood grade III meningioma, recurrent childhood cerebellar astrocytoma, recurrent childhood cerebral astrocytoma, childhood high-grade cerebral astrocytoma, childhood low-grade cerebral astrocytoma, childhood choroid plexus tumor, childhood craniopharyngioma, childhood infratentorial ependymoma, childhood supratentorial ependymoma, recurrent childhood ependymoma, recurrent childhood medulloblastoma, childhood oligodendroglioma, recurrent childhood supratentorial primitive neuroectodermal tumor, leptomeningeal metastases, recurrent carcinoma of unknown primary, childhood central nervous system germ cell tumor, childhood chronic myelogenous leukemia, juvenile myelomonocytic leukemia, recurrent/refractory childhood Hodgkin lymphoma, recurrent childhood grade III lymphomatoid granulomatosis, recurrent childhood visual pathway and hypothalamic glioma, childhood atypical teratoid/rhabdoid tumor, recurrent childhood large cell lymphoma, recurrent childhood lymphoblastic lymphoma, recurrent childhood small noncleaved cell lymphoma, relapsing chronic myelogenous leukemia, recurrent childhood pineoblastoma, recurrent childhood subependymal giant cell astrocytoma, meningeal leukemia, secondary central nervous system Hodgkin lymphoma, secondary central nervous system non-Hodgkin lymphoma
Eligibility Criteria
DISEASE CHARACTERISTICS: Diagnosis of neoplastic meningitis secondary to leukemia, lymphoma (including AIDS-related lymphoma), or solid tumor (including primary CNS tumors or carcinomas of unknown primary site), defined by 1 of the following criteria: Cerebral spinal fluid (CSF) cell count > 5/μL AND evidence of blast cells on cytospin or by cytology (for patients with leukemia or lymphoma) Presence of tumor cells on cytospin or cytology OR unequivocal presence of meningeal disease by MRI (for patients with solid tumor) No conventional therapy for neoplastic meningitis exists Patients with CNS leukemia or lymphoma must be refractory to conventional therapy, including radiotherapy (i.e., second or greater relapse) Patients with CNS leukemia or lymphoma must have had a negative bone marrow aspiration within the past 2 weeks No clinical evidence of obstructive hydrocephalus No compartmentalization of CSF flow by radioisotope indium In 111 or technetium Tc 99 DTPA flow study No ventriculoperitoneal or ventriculoatrial shunt unless patient is completely shunt-independent No impending spinal cord compression or other CNS involvement (e.g., acute visual loss secondary to optic nerve involvement) requiring emergent local radiotherapy PATIENT CHARACTERISTICS: Age 3 to 21 Performance status Lansky 60-100% (≤ 16 years of age) OR Karnofsky 60-100% (> 16 years of age) Life expectancy Not specified Hematopoietic Not specified Hepatic Not specified Renal Calcium ≥ 7 mg/dL Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception Sodium 125-150 mmol/L Magnesium ≥ 0.7 mmol/L Must have or be willing to have an intraventricular access device (i.e., Ommaya reservoir) No uncontrolled infection HIV-positive patients with AIDS-related lymphomatous meningitis are eligible No other significant uncontrolled systemic medical illness that would preclude study participation PRIOR CONCURRENT THERAPY: Biologic therapy Recovered from prior biologic therapy or immunotherapy Chemotherapy Recovered from prior chemotherapy At least 1 week since prior intra-colony stimulating factory (CSF) chemotherapy (2 weeks for liposomal cytarabine) At least 3 weeks since prior systemic chemotherapy for leptomeningeal disease Concurrent systemic chemotherapy to control systemic disease or bulk CNS disease allowed provided the systemic chemotherapy is not an investigational agent OR any of the following: High-dose (> 1 g/m^2) methotrexate High-dose (> 1 g/m^2) cytarabine Fluorouracil Capecitabine Thiotepa Nitrosoureas Topotecan Endocrine therapy Not specified Radiotherapy See Disease Characteristics At least 8 weeks since prior craniospinal radiotherapy and recovered No concurrent CNS radiotherapy Concurrent radiotherapy to extra-CNS sites (e.g., painful bone metastases not in the craniospinal axis) allowed Surgery Not specified Other More than 2 weeks since prior and no other concurrent investigational agents No other concurrent intra-CSF or systemic therapy for leptomeningeal disease
Sites / Locations
- UCSF Helen Diller Family Comprehensive Cancer Center
- Children's National Medical Center
- Children's Memorial Hospital - Chicago
- Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office
- Dana-Farber/Harvard Cancer Center at Dana-Farber Cancer Institute
- Duke Comprehensive Cancer Center
- Children's Hospital of Philadelphia
- Children's Hospital of Pittsburgh
- St. Jude Children's Research Hospital
- Dan L. Duncan Cancer Center at Baylor College of Medicine
- Children's Hospital and Regional Medical Center - Seattle