Shuper Avinoam, Stark Batia, Kornreich Liora, Cohen Ian J, Avrahami Gali, Yaniv Isaac
Department of Pediatric Oncology-Hematology, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.
Isr Med Assoc J. 2002 Nov;4(11):1050-3.
The addition of methotrexate to treatment protocols in children with acute lymphoblastic leukemia has been found beneficial in preventing central nervous system relapse. However, MTX itself may be associated with neurologic morbidities, the most significant of which is leukoencephalopathy. The present study describes the clinical spectrum of leukoencephalopathy, which ranges from a subclinical disease manifested only radiologically to a progressive, devastating encephalopathy. The interaction of MTX with other components of the treatment protocol is discussed, as is the effect of leucovorin. A summary is presented of the metabolic pathways that may be involved in the development of MTX toxicity. Researchers are still seeking a biochemical marker to aid in the determination of the amount of MTX that may be safely administered.
在急性淋巴细胞白血病患儿的治疗方案中加入甲氨蝶呤已被发现有助于预防中枢神经系统复发。然而，甲氨蝶呤本身可能与神经疾病相关，其中最严重的是白质脑病。本研究描述了白质脑病的临床谱，其范围从仅通过影像学表现的亚临床疾病到进行性、毁灭性的脑病。讨论了甲氨蝶呤与治疗方案中其他成分的相互作用以及亚叶酸钙的作用。总结了可能参与甲氨蝶呤毒性发生的代谢途径。研究人员仍在寻找一种生化标志物，以帮助确定可安全给药的甲氨蝶呤剂量。
