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Methotrexate-induced subacute myelopathy: a serious but treatable complication
Takashi Miyoshi1, Tadakazu Kondo2,3, Momoko Nishikori3
1Division of Hematology and Oncology, Shiga General Hospital, Moriyama, Japan.
Abstract:
Subacute myelopathy is a rare but serious complication of methotrexate (MTX) that may cause paraplegia. Although its underlying mechanisms have not been fully elucidated, homocysteine is thought to play a role in the pathogenesis of this adverse effect. Herein, we report the case of a 34-years old female patient with diffuse large B-cell lymphoma who developed progressive paraplegia accompanied by dysfunctional bladder and bowel movements after treatment with a modified CODOX-M/IVAC regimen, including high-dose intravenous MTX and intrathecal (IT-) MTX. Neurological symptoms gradually improved to almost normal levels within 4.5 months of onset following treatment with a combination of S-adenosylmethionine, methionine, cyanocobalamin, and folate. During chemotherapy, including high-dose MTX and IT-MTX for hematological malignancies, MTX-induced subacute neuronal damage should be carefully evaluated, and appropriate treatment should be initiated as early as possible.
Insights
Methotrexate (MTX) chemotherapy can cause subacute myelopathy, leading to paraplegia. Early treatment with specific supplements like S-adenosylmethionine can reverse these serious neurological effects.
Area of Science:
- Neuroscience
- Oncology
- Pharmacology
Background:
- Subacute myelopathy is a rare but severe complication of methotrexate (MTX) treatment.
- High-dose and intrathecal (IT) MTX regimens are used for hematological malignancies.
- The exact mechanisms of MTX-induced myelopathy are not fully understood, but homocysteine is implicated.
Observation:
- A 34-year-old female with diffuse large B-cell lymphoma developed progressive paraplegia and bowel/bladder dysfunction after modified CODOX-M/IVAC chemotherapy.
- This regimen included high-dose intravenous and intrathecal MTX.
- Neurological symptoms showed significant improvement within 4.5 months.
Findings:
- The patient's neurological deficits improved with a combination therapy of S-adenosylmethionine, methionine, cyanocobalamin, and folate.
- This suggests a potential therapeutic strategy for MTX-induced subacute neuronal damage.
Implications:
- MTX-induced subacute neuronal damage requires careful evaluation during chemotherapy for hematological malignancies.
- Prompt initiation of appropriate treatment, potentially including the described supplement regimen, is crucial for managing this adverse effect.
- This case highlights the importance of recognizing and treating MTX neurotoxicity to improve patient outcomes.
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