CN-02 * MYELOPATHY FOLLOWING INTRATHECAL CHEMOTHERAPY: A CASE SERIES IN ADULTS
| Autor: | Naval Daver, Chelsea C. Pinnix, Linda Chi, Karen Woodman, Carlos Kamiya-Matsouka, David Cachia |
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| Rok vydání: | 2014 |
| Předmět: |
Cancer Research
medicine.medical_specialty Chemotherapy business.industry medicine.medical_treatment medicine.disease Chemotherapy regimen Gastroenterology Surgery Discontinuation Leukoencephalopathy Abstracts Myelopathy Oncology Internal medicine medicine Cytarabine Methotrexate Neurology (clinical) Arachnoiditis business medicine.drug |
| Zdroj: | Neuro-Oncology. 16:v46-v46 |
| ISSN: | 1523-5866 1522-8517 |
| DOI: | 10.1093/neuonc/nou243.2 |
| Popis: | Intrathecal (IT) chemotherapy in combination with systemic chemotherapy is an effective treatment modality used in the prophylaxis and treatment of CNS disease in hematological malignancies. IT agents commonly used in various chemotherapeutic regimens include methotrexate and cytarabine arabinoside (Ara-C).Side effects from IT chemotherapies described in the literature vary from mild asymptomatic forms of arachnoiditis diagnosed on MRI to leukoencephalopathy and myelopathy. These complications have been reported more frequently in the pediatric literature than in adults. We here describe 7 adult patients treated at a single institution for hematological malignancies that developed myelopathy following intrathecal chemotherapy. 5 out of our 7 patients demonstrated longitudinal hyperintenities involving mostly the dorsal columns and to varying degrees the lateral corticospinal tracts; a picture suggesting methotrexate induced toxicity. In the 2 cases where myelobasic protein was checked in the CSF, it was significantly elevated supporting the role of a potential CSF biomarker to diagnose cord injury and distinguish the pathology from leukemic infiltration. Median survival was 3.1 months from the time of myelopathy diagnosis despite various treatment strategies employed. We did not find any correlation between number of IT methotrexate doses given and development of myelopathy indicating a potential individual sensitivity to methotrexate. Based on what is known, immediate discontinuation of intrathecal methotrexate treatment would be recommended once a diagnosis of IT induced melopathy is made with consideration of methionine or S-adenosylmethionine supplementation for patients who received IT methotrexate. |
| Databáze: | OpenAIRE |
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