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Adverse effects of intrathecal methotrexate in children with acute leukemia
in remission
CF Geiser, Y Bishop, N Jaffe, L Furman, D Traggis and E Frei
A toxic syndrome characterized by fever, headache, and vomiting, lasting
2-5 days, occurred in 61% of 39 children with acute leukemia in complete
remission, receiving central nervous system prophylaxis with intrathecal
methotrexate, and in 14% of 34 children receiving the same plus cranial
radiation. The syndrome was accompanied by pleocytosis with lymphocytes,
monocytoid cells, and neutrophils. There was evidence of cumulative Mtx
toxicity, since the toxic syndrome occurred mostly after the third and
fourth dose and did not recur with longer intervals between doses. The
incidence of the syndrome was significantly reduced by the use of Elliott's
B solution as Mtx diluent, rather than water or normal saline. The
occurrence of pleocytosis and toxic clinical syndrome was also
significantly reduced in patients receiving concomitant cranial radiation,
probably due to the lympholytic action of radiotherapy and the depressed
cellular response of irradiated tissues. The use of Elliott's B solution as
diluent for IT Mtx and an appropriate interval between Mtx doses are
suggested for prevention of this toxic syndrome.
Volume 45,
Issue 2,
pp. 189-195,
02/01/1975
Copyright © 1975 by The American Society of Hematology
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