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Methotrexate Treatment Protocols and the Central Nervous System: Significant Cure With Significant Neurotoxicity

Department of Hematology-Oncology, Tel Aviv University, Tel Aviv, Israel, icohen{at}ccsg.tau.ac.il

Batya Stark, MD

Department of Hematology-Oncology, Tel Aviv University, Tel Aviv, Israel

Liora Kornreich, MD

Department of Imaging Schneider Children's Medical Center of Israel

Ian J. Cohen, MB, ChB

Department of Hematology-Oncology, Tel Aviv University, Tel Aviv, Israel

Shraga Aviner, MD

Department of Hematology-Oncology, Tel Aviv University, Tel Aviv, Israel

Adam Steinmetz, MD

Department of Nuclear Medicine Rabin Medical Center, Beilinson Campus, Petah Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Jeremiah Stein, MD

Department of Hematology-Oncology, Tel Aviv University, Tel Aviv, Israel

Yaacov Goshen, MD

Department of Hematology-Oncology, Tel Aviv University, Tel Aviv, Israel

Isaac Yaniv, MD

Department of Hematology-Oncology, Tel Aviv University, Tel Aviv, Israel

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. (J Child Neurol 2000;15:573-580).

Journal of Child Neurology, Vol. 15, No. 9, 573-580 (2000)
DOI: 10.1177/088307380001500902


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