Methotrexate treatment protocols and the central nervous system: significant cure with significant neurotoxicity.
Methotrexate can influence the central nervous system through several metabolic toxic pathways. These effects can be categorized as immediate, acute to subacute, or chronic neurologic syndromes. The acute to subacute syndrome occurs frequently in acute lymphoblastic leukemia treatment protocols, generally manifesting with focal neurologic signs and changes seen on magnetic resonance imaging and single photon emission computed tomography. While in some patients the neurotoxicity is transient and benign and allows for continuation of chemotherapy, in others it can be quite severe and debilitating, leading to permanent neurologic deficits. The need to modify the treatment protocols when neurotoxicity appears is not fully established. It is also unknown whether the use of sufficient amounts of leucovorin can overcome the toxic effects of the drug.
Shuper
A
A
Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tiqva. icohen@ccsg.tau.ac.il
Stark
B
B
Kornreich
L
L
Cohen
I J
IJ
Aviner
S
S
Steinmetz
A
A
Stein
J
J
Goshen
Y
Y
Yaniv
I
I
D000293:Adolescent; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000378:metabolism / Q000627:therapeutic use; D002490:Central Nervous System / Q000000981:diagnostic imaging / Q000473:pathology; D002493:Central Nervous System Diseases / Q000139:chemically induced* / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D006801:Humans; D002955:Leucovorin / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000378:metabolism / Q000627:therapeutic use; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy; D015899:Tomography, Emission-Computed, Single-Photon
D000964:Antimetabolites, Antineoplastic; D002955:Leucovorin; D008727:Methotrexate