Intrathecal therapy (lumbar puncture, Ommaya reservoir)
Giving drugs directly into the fluid around the brain and spinal cord, by needle in the lower back or through a small reservoir under the scalp, because most drugs cannot cross from the blood into that space.
Intrathecal methotrexate and cytarabine prevent and treat central nervous system leukaemia and lymphoma and are given by lumbar puncture, which also samples cerebrospinal fluid for leukaemic cells or ctDNA. An Ommaya reservoir connects to a ventricular catheter for repeated intraventricular dosing and is the route for locoregional CAR-T in glioblastoma and leptomeningeal disease trials. Intrathecal trastuzumab is used for HER2-positive leptomeningeal metastases.
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