Moseley, Robin Peter; (1991) Aspects of monoclonal antibody technology in diagnosis and therapy of neoplastic meningitis. Doctoral thesis (M.D), UCL (University College London).

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Abstract

This study includes an introductory review of current diagnostic, clinical and therapeutic aspects of neoplastic meningitis. Emphasis is placed on the importance of early detection of leptomeningeal tumour, as current therapeutic strategies are more effective against minimal disease. The enhancement of conventional diagnostic cytology by the addition of monoclonal antibody immunocytochemistry is discussed and, subsequently illustrated in a study of 12 patients with neoplastic meningitis. The use of monoclonal antibodies in radioimmunoassay methods is then demonstrated by the development of an immunoradiometric assay for the detection of Polymorphic Epithelial Mucin (PEM) in cerebrospinal fluid (CSF). This high molecular weight glycoprotein has not been previously assayed for in CSF and its potential value as a new diagnostic biochemical marker for carcinomatous meningitis is assessed. Finally, in a study of 15 patients with neoplastic meningitis, the potential therapeutic application of monoclonal antibodies as vectors of targeted radiation is explored. Monoclonal antibodies labelled with I-131 were administered directly into ventricular CSF, and demonstrable therapeutic responses were seen in 3/15 patients. Toxicity was seen in the form of bone marrow suppression in 3/15 patients and epilepsy in 2/15 patients.

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