Liposomal cytarabine: new drug. Lymphomatous meningitis: no better than standard cytarabine.

(1) If left untreated, lymphomatous meningitis leads to gradual neurological deterioration and death within a median of 4 to 6 weeks. Palliative care is usually based on a combination of radiotherapy and intravenous and intrathecal cytarabine and/or methotrexate, postponing death by a few weeks. (2) European approval has been granted for liposomal cytarabine for this indication. (3) An unblinded trial involving 33 patients compared liposomal cytarabine with standard cytarabine. There was no difference between the groups with respect to survival time (between 2 and 3 months), time to neurological deterioration (about two months), general health status, mental health, or quality of life despite the greater frequency of eradication of malignant cells in the cerebrospinal fluid. (4) Patients receiving liposomal cytarabine were more likely to experience headache (27% versus 2% with standard cytarabine), nausea (9% versus 2%), vomiting (8% versus 4%), arachnoiditis (reversible with steroid therapy) (4% versus 0%), and confusion (7% versus 0%). (5) Only 4 injections of liposomal cytarabine are needed during the first two months of treatment, compared with 12 injections of standard cytarabine. (6) In practice, the longer dosing interval with liposomal cytarabine is not associated with a gain in efficacy or quality of life, mainly because adverse effects are more common than with standard cytarabine.