Is chemotherapy on the spinal cord ever used in adult AML?

Is chemotherapy on the spinal cord ever used in adult AML? Pediatric leukemia is predominantly ALL, or acute lymphoblastic leukemia, the standard of which requires chemotherapy into the brain. In adults, most of leukemia is acute myeloid leukemia, where generally the presence of CNS involvement with AML is quite low, so we don't use that as the standard. There are a few patients who will present with CNS involvement, in which case you would give chemotherapy into the spine, but it is not the most common presentation, and most patients will not have CNS involvement. Patients who are adults do have ALL. It's just less common than acute myeloid leukemia. So adults with ALL are treated sort of similar to how children with ALL would be to get chemotherapy into the brain, because the biologically dead disease is ALL, acute lymphoblastic leukemia. But AML is not a disease that is the most predominant kind of leukemia in adults. It does not generally present with CNS involvement or have a risk of high CNS relapse in the future, so we don't use that as standard.