Topotecan Hydrochloride in Treating Children With Meningeal Cancer That Has Not Responded to Previous Treatment

Inclusion Criteria:

Histologically proven refractory leukemia, lymphoma, or other solid tumor thathas overt meningeal involvement (Recurrent CNS acute lymphoblastic leukemia stratum only open to accrual as of 11/30/04)

Definition of meningeal disease:

Leukemia/lymphoma (including acute lymphoblastic leukemia)

CSF cell count greater than 5/mm^3 AND evidence of blast cells oncytospin preparation or by cytology
Refractory to conventional therapy, including radiotherapy (i.e., in second or greater relapse)
No concurrent bone marrow relapse

Solid tumors (including medulloblastoma)

Presence of tumor cells on cytospin preparation or cytology OR presence ofmeningeal disease on MRI scans

No clinical evidence of obstructive hydrocephalus or compartmentalization ofCSF flow as documented by radioisotope indium In 111 or technetium Tc 99 DTPAflow study

If CSF flow block is demonstrated, focal radiotherapy must be administered tosite of block to restore flow and a repeat CSF flow study must show clearing of blockage

No ventriculoperitoneal or ventriculoatrial shunt unless:

Patient is shunt independent and there is evidence that the shunt is nonfunctional
CSF flow study demonstrates normal flow
No impending cord compression, CNS involvement requiring local radiotherapy(e.g., optic nerve), or isolated bulky ventricular or leptomeningeal basedlesions
Performance status - Lansky 50-100% (age 10 and under)
Performance status - Karnofsky 50-100% (over age 10)
At least 8 weeks
Platelet count greater than 40,000/mm^3 (transfusions allowed)
Bilirubin less than 2.0 mg/dL
SGPT less than 5 times normal
Creatinine less than 1.5 mg/dL
Electrolytes, calcium, and phosphorus normal
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
No significant illness (e.g., uncontrolled infection, except HIV [i.e., AIDS-related lymphomatous meningitis])
Prior immunotherapy allowed and recovered
At least 3 weeks since systemic CNS directed chemotherapy (6 weeks for nitrosoureas) and recovered
At least 1 week since prior intrathecal (IT) chemotherapy (2 weeks for cytarabine [liposomal])
No prior IT chemotherapy on days -14 to -7 before study entry unless evidence of disease progression (e.g., increasing WBC and percentage blasts in patients with leukemia/lymphoma or increased leptomeningeal enhancements in patients with solid tumors) (Recurrent CNS acute lymphoblastic leukemia stratum only open to accrual as of 11/30/04)
Concurrent chemotherapy to control systemic disease or bulk CNS disease allowed if the systemic chemotherapy is not a phase I study agent that significantly penetrates the CSF (e.g., high-dose systemic methotrexate [greater than 1 g/m^2], thiotepa, high-dose cytarabine, temozolomide, IV mercaptopurine, nitrosourea, or topotecan) or an agent known to have serious unpredictable CNS side effects
Concurrent dexamethasone or prednisone allowed if part of a systemic chemotherapy regimen
See Disease Characteristics
At least 8 weeks since prior cranial irradiation and recovered
No concurrent whole brain or craniospinal irradiation

At least 7 days since prior investigational drug

Time period should be extended if patient has received any investigational agent that is known to have delayed toxic effects after 7 days or a prolonged half-life
No other concurrent investigational agents
No concurrent therapy (IT or systemic) for leptomeningeal disease
No other concurrent systemic agents that significantly penetrate the blood-brain barrier