Topotecan in Treating Young Patients With Neoplastic Meningitis Due to Leukemia, Lymphoma, or Solid Tumors

Inclusion 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