Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.
Homi Bhabha National Institute, Mumbai, India.
Leuk Lymphoma. 2023 Dec;64(12):1971-1980. doi: 10.1080/10428194.2023.2245093. Epub 2023 Aug 11.
Methotrexate-induced neurotoxicity is a well-defined side-effect of high-dose and intrathecal methotrexate with characteristic clinico-radiological findings and transient nature. Our experience in managing this entity in children with acute lymphoblastic leukemia(ALL) is reported here. All children with de novo ALLregistered from January 2016 through December 2021 who developed methotrexate-induced neurotoxicity were included. Of children with ALL treated during the study period, thirty-three experienced methotrexate induced neurotoxicity with an incidence of 1.25%. Stroke-like symptoms(36.36%; 12/33) were the most common clinical manifestation followed by seizures(30.3%, 10/33). Twenty-three patients had radiological features consistent with methotrexate-induced leukoencephalopathy. With emerging evidence, thirty-one patients were re-challenged with methotrexate (IV/IT), of whom 4 patients had recurrence of symptoms. No long-term neurological sequalae were noted in our cohort, despite rechallenging. Therefore in our study, methotrexate induced neurotoxicity is a self-limiting toxicity and methotrexate can be re-challenged safely without compromising theintensity of CNS-directed therapy.
甲氨蝶呤诱导的神经毒性是大剂量鞘内甲氨蝶呤治疗的明确副作用，具有特征性的临床放射学表现和短暂性。我们在此报告在急性淋巴细胞白血病（ALL）患儿中管理这种疾病的经验。所有 2016 年 1 月至 2021 年 12 月期间初诊的 ALL 患儿，凡发生甲氨蝶呤诱导的神经毒性者均纳入研究。在研究期间，有 33 例 ALL 患儿出现甲氨蝶呤诱导的神经毒性，发生率为 1.25%。最常见的临床表现为类似中风的症状（36.36%，12/33），其次是癫痫（30.3%，10/33）。23 例患者的影像学特征与甲氨蝶呤诱导的白质脑病一致。随着新证据的出现，31 例患者重新接受甲氨蝶呤（IV/IT）治疗，其中 4 例患者出现症状复发。尽管重新接受治疗，但我们的队列中没有出现长期神经后遗症。因此，在我们的研究中，甲氨蝶呤诱导的神经毒性是一种自限性毒性，可以安全地重新挑战甲氨蝶呤，而不会影响中枢神经系统定向治疗的强度。
