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Reversible treatment-related leukoencephalopathy
C T Gay1, J B Bodensteiner, R Nitschke
1Department of Neurology, West Virginia University Health Science Center, Morgantown 26506.
Journal of Child Neurology
|July 1, 1989
Summary
Two children developed leukoencephalopathy, a white matter brain condition, after receiving chemotherapy for acute lymphocytic leukemia. Combining intravenous cytarabine (ara-C) and methotrexate can increase central nervous system toxicity risk.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Chemotherapy Toxicity
Background:
- Acute lymphocytic leukemia (ALL) is a common childhood cancer.
- Consolidation chemotherapy regimens often include agents like cytarabine and methotrexate.
- Central nervous system (CNS) prophylaxis and treatment are crucial in ALL management.
Observation:
- Two pediatric patients with ALL developed neurological symptoms during consolidation chemotherapy.
- Cranial MRI revealed significant white matter changes (leukoencephalopathy) in both patients.
- Computed tomography (CT) scans were normal in one patient, highlighting MRI's sensitivity.
Findings:
- The combination of intravenous cytarabine (ara-C) and methotrexate was administered during the consolidation phase.
- Leukoencephalopathy emerged as a potential synergistic neurotoxicity of this chemotherapy combination.
- Symptoms resolved within 1-2 weeks after treatment modification, with radiological resolution over 6-12 months.
Implications:
- This case series highlights a potentially serious CNS complication of combined ara-C and methotrexate chemotherapy in ALL.
- Early recognition of chemotherapy-induced leukoencephalopathy is facilitated by MRI.
- Awareness among clinicians can lead to timely intervention and management adjustments, improving patient outcomes.