Severe complications after intrathecal methotrexate (MTX) for treatment of primary central nervous system lymphoma (PCNSL).
Primary central nervous system lymphoma (PCNSL) is a rare and highly malignant tumor with increasing incidence. Survival has improved with the use of nonsurgical treatment modalities, of which methotrexate (MTX)-based intrathecal chemotherapy has been an important option. Here, we describe devastating complications in three patients with diffuse large B-cell lymphomas. After intrathecal MTX therapy two patients died secondary to fulminant brain edema. A third patient developed severe dementia, gait disturbance and urinary incontinence due to leukencephalopathy. Since bulky disease was present in all three patients, CSF flow may have been impaired. This might have exposed adjacent tissue to prolonged toxic drug concentrations. Regarding the severe complications seen in these patients, it is useful to consider high-dose intravenous MTX treatment only in periventricular PCNSL.
Department of Neurosurgery, University Hospital, Klinikum Mannheim, Theodor Kutzer Ufer 1-3, D-68167 Mannheim, Germany. ralf.weigel@nch.ma.uni-heidelberg.de
Ralf
R
Weigel
Pascal
P
Senn
Joachim
J
Weis
Joachim K
JK
Krauss
D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000633:toxicity*; D001929:Brain Edema / Q000139:chemically induced* / Q000473:pathology; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000473:pathology; D002551:Cerebral Ventricle Neoplasms / Q000188:drug therapy* / Q000473:pathology; D002552:Cerebral Ventricles / Q000187:drug effects / Q000473:pathology; D003704:Dementia / Q000139:chemically induced* / Q000473:pathology; D004677:Encephalocele / Q000139:chemically induced / Q000473:pathology; D004724:Endoscopy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000633:toxicity*; D008875:Middle Aged; D013702:Temporal Lobe / Q000473:pathology; D014057:Tomography, X-Ray Computed
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate