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Intrathecal MTX

Sayaka Akaike, Koju Kamoi, Mari Tezuka, Daisuke Tomizawa, Ryoichi Yoshimura, Masatoshi Takagi, Kyoko Ohno-Matsui
BACKGROUND: Myeloid/NK cell precursor acute leukemia (MNKL) is a rare type of leukemia, and ocular complications have not previously been reported. We now report a patient with MNKL who developed intraocular infiltrates during follow-up. METHODS AND RESULTS: A 13-year-old boy diagnosed with MNKL developed left eye pain 3 months after starting treatment. Examination of the left eye revealed a visual acuity of counting fingers at 20 cm, ciliary hyperemia, small corneal keratic precipitates, hypopyon, grade 4 vitreous opacities, and an obscured fundus...
September 2016: Medicine (Baltimore)
Jeanette K Doorduijn, Gustaaf W van Imhoff, Bronno van der Holt, Harry C Schouten, Martijn R Schaafsma, Marius A MacKenzie, Joke W Baars, Marie José Kersten, Pieternella J Lugtenburg, Martin J van den Bent, Roelien H Enting, Fokje M Spoelstra, Philip Poortmans, Jacoline E C Bromberg
The prognosis of central nervous system (CNS) relapse of systemic non-Hodgkin lymphoma is poor with 1-year survival historically at 0% to 20%. Aiming to improve these results, we performed a multicenter phase 2 study in patients with a CNS relapse, with or without concurrent systemic relapse. Treatment consisted of 2 cycles of R-DHAP alternating with high-dose methotrexate (MTX) and was combined with intrathecal rituximab. Responding patients received a third R-DHAP-MTX cycle followed by busulfan and cyclophosphamide myeloablative therapy and autologous stem cell transplantation...
August 17, 2016: Hematological Oncology
Elif Kazancı, Hüseyin Gülen, Ayşe Erbay, Canan Vergin
We report two male cases (4- and 5-years-old) of intrathecal methotrexate overdose. The two boys with acute lymphoblastic leukemia were to receive intrathecal injection of methotrexate. Instead of the prescribed 12 mg, they both received a dose of 120 mg. The initial cerebrospinal fluid samples showed methotrexate concentration of 2.24x10-2M in case 1 and 1.32x10-2M in case 2. The cases were successfully treated with cerebrospinal fluid (CSF) exchange and intravenous folinic acid rescue. The favorable outcome in our cases suggests that CSF exchange is safe and that folinic acid rescue may be adequate to prevent sequelae in patients subjected to intrathecal MTX overdoses up to 120 mg...
March 5, 2011: Turkish Journal of Haematology: Official Journal of Turkish Society of Haematology
Xi Wu, Junling Li, Jianping Xiao, Boyan Yang, Lei Yu, Xiaoming Wu, Jinghai Wan, Haiyan Xu, Jianxin Kong
BACKGROUND: Leptomeningeal carcinomatosis is a rare type of metastatic tumors of the central nervous system. In recent years, with the improvement of neoplasms therapies and longer survival of patients by better systemic control, incidence of leptomeningeal metastases has increased every year. However, there is still lack of effective therapies. The aim of this study is to investigate the efficacy, security and prognosis of intrathecal chemotherapy with methotrexate (MTX) in the treatment of neoplastic meningitis...
May 20, 2016: Zhongguo Fei Ai za Zhi, Chinese Journal of Lung Cancer
Liren Qian, Chunhui Zhou, Jianliang Shen, Jian Cen, Wenjie Yin
BACKGROUND: Primary central nervous system lymphoma (PCNSL) is a rare subtype of non-Hodgkin's lymphoma (NHL). The aim was to evaluate response rate, progression free survival (PFS), overall survival (OS), and toxicity in PCNSL after systemic R-IDARAM and intrathecal immunochemotherapy with deferred radiotherapy. RESULTS: The response rate was 94% with 17 (89%) complete responses and 1 (5%) partial responses. Follow-up time is from 5 to 63 months (median, 39 months)...
May 3, 2016: Oncotarget
Takahisa Yamasaki, Hirokazu Fukui, Hiroo Sei, Ken Hara, Hirotsugu Eda, Takashi Kondo, Fumihiko Toyoshima, Tomoaki Kono, Katsuyuki Tozawa, Hisatomo Ikehara, Toshihiko Tomita, Tadayuki Oshima, Jiro Watari, Hiroto Miwa
A 35-year-old man was diagnosed to have gastric cancer by endoscopic and histological examinations. Staging laparoscopy detected peritoneal metastasis. Systemic chemotherapy was started, but the patient complained of severe headache. Subsequently, a lumbar puncture demonstrated adenocarcinoma cells in the spinal fluid, suggesting the occurrence of meningeal carcinomatosis (MC) from gastric cancer. MC occurs only rarely in patients with gastric cancer, but the prognosis is invariably poor. However, this patient nevertheless survived for 12 months after receiving intrathecal MTX/Ara-C together with systemic chemotherapy...
2016: Internal Medicine
Yandi Chen, Lifeng An, Guanghua Jin
To study the pathogenesis of hearing loss in chronic myelogenous leukemia (CML). To report one case with CML whose first sign was sudden unilateral hearing loss. Sudden hearing loss in CML was presented with dramatic high white blood cell count in peripheral blood. Some cases of sudden hearing loss in CML may be improved or even cured by leukapheresis and intrathecal chemotherapy. The proposed pathogenesis for deafness in leukemia is due to hyperleukocytosis, hyperviscosity syndrome, leukemic infiltration and the inner ear hemorrhage...
May 2015: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
Ho-Shin Gwak, Sang Hyun Lee, Weon Seo Park, Sang Hoon Shin, Heon Yoo, Seung Hoon Lee
Treatment of Leptomeningeal carcinomatosis (LMC) from solid cancers has not advanced noticeably since the introduction of intra-cerebrospinal fluid (CSF) chemotherapy in the 1970's. The marginal survival benefit and difficulty of intrathecal chemotherapy injection has hindered its wide spread use. Even after the introduction of intraventricular chemotherapy with Ommaya reservoir, frequent development of CSF flow disturbance, manifested as increased intracranial pressure (ICP), made injected drug to be distributed unevenly and thus, the therapy became ineffective...
July 2015: Journal of Korean Neurosurgical Society
Sarita Depani, Kondwani Banda, Simon Bailey, Trijn Israels, George Chagaluka, Elizabeth Molyneux
BACKGROUND: We previously reported a 28-day treatment protocol for children with endemic Burkitt lymphoma (BL) which included four doses of cyclophosphamide (CPM), intrathecal methotrexate and hydrocortisone (IT MTX/HC) at Queen Elizabeth Central Hospital (QECH) in Malawi which resulted in an Event-Free Survival (EFS) of 50% at 1 year. METHODS: In an attempt to improve survival whilst maintaining acceptable toxicity, brevity, low-cost and a standard treatment for all patients, four doses of vincristine (VCR) at 1...
November 2015: Pediatric Blood & Cancer
Jaspreet Chahal, Alison Stopeck, Kathryn Clarke, Robert B Livingston, Pavani Chalasani
Leptomeningeal carcinomatosis (LMC) secondary to metastatic breast cancer (MBC) has increased in incidence with improved systemic disease control. Current treatment options include radiation therapy (to symptomatic sites) and systemic treatment [intrathecal (IT) or intravenous (IV) chemotherapy]. Methotrexate (MTX), thiotepa and cytarabine are the most commonly used IT agents, while high-dose MTX is the most common IV regimen. While IT treatments are generally well tolerated, complications like chemical meningitis, leukoencephalopathy, etc...
September 2015: Neurological Sciences
Thomas C Chen, Gina R Napolitano, Frank Adell, Axel H Schönthal, Yehoshua Shachar
Patients with leptomeningeal carcinomatosis face a particularly grim prognosis. Current treatment consists of intrathecal delivery of methotrexate (MTX) or cytosine arabinoside (Ara-C) via Ommaya reservoir or lumbar puncture. Yet despite these interventions, the median survival after diagnosis is only 4-7 months. To address inherent shortcomings of current treatments and provide a more effective therapeutic approach, the Pharmaco-Kinesis Corporation has developed a novel type of implantable pump capable of delivering intrathecal chemotherapy (i...
August 2015: Journal of Neurosurgery
Naofumi Ogushi, Kazuaki Sasaki, Minoru Shimoda
The effect of the antitumor drug, methotrexate (MTX), which is applied to brain tumors, is restricted by the blood-brain barrier (BBB), which is composed of P-glycoprotein (P-gp) and multidrug resistance associated protein (MRP). We, therefore, studied if a potent P-gp and MRP modulator, cyclosporin A (CysA), can modulate the MTX concentration in the rat brain. If it can, which route is more effective, intravenous or intrathecal? We intravenously or intrathecally administered MTX to rats with or without CysA...
September 2015: Journal of Veterinary Medical Science
Min Jae Park
BACKGROUND: As the incidence of meningeal carcinomatosis (MC) in non-small cell lung cancer (NSCLC) patients has been increasing, MC has recently become an important clinical problem in the management of NSCLC. However, development of new treatments is lacking and a standard treatment guideline is not yet available. Research on salvage intrathecal chemotherapy after failure of first-line treatment for NSCLC patients with MC has rarely been reported in the literature. Here, we report the case of an NSCLC patient with MC who showed durable response to salvage intrathecal etoposide subsequent to failure of first-line methotrexate...
2015: American Journal of Case Reports
Mizuki Watanabe, Daisuke Kaji, Meiko Hashimoto-Maeda, Go Yamamoto, Yuki Asano-Mori, Naoyuki Uchida, Shuichi Taniguchi, Koji Izutsu
A 52-year-old female presented with stroke-like symptoms after high-dose methotrexate (HDMTX) therapy and MTX intrathecal injection (IT-MTX) as central nervous system (CNS) prophylaxis for intravascular large B-cell lymphoma (IVLBCL). She had been diagnosed as having IVLBCL without CNS involvement 5 months earlier and had received 6 courses of R-CHOP and 2 courses of HDMTX combined with IT-MTX. She experienced acute-onset right hemiparesis involving the face and arm, along with dysarthria, 7 days after the second HDMTX infusion...
March 2015: [Rinshō Ketsueki] the Japanese Journal of Clinical Hematology
Jung-Hoon Noh, Min Ho Lee, Won Seog Kim, Do Hoon Lim, Sung Tae Kim, Doo-Sik Kong, Do-Hyun Nam, Jung-Il Lee, Ho Jun Seol
BACKGROUND: Glioblastoma (GBM) is the most common and malignant brain tumor in adults. Despite therapeutic advances, almost all patients eventually experience tumor recurrence. Leptomeningeal spread (LMS) is not a rare condition of recurrence. However, the standard management protocol of LMS has not been established. The aim of this study is to report the risk of (LMS) and the prognosis between treatment modalities in GBM patients. METHODS: A retrospective review was conducted of 321 patients who were diagnosed with GBM between January 2006 and December 2010...
April 2015: Acta Neurochirurgica
Winfried H Alsdorf, Michael Schmitz, Aneta Schieferdecker, Judith Dierlamm, Carsten Bokemeyer, Mascha Binder
We report a patient with refractory diffuse large B-cell lymphoma who developed irreversible, severe spinal neurotoxicity after concurrent treatment with intrathecal and systemic cytarabine. Shortly after concomitant administration of intrathecal triple therapy (MTX, dexamethasone and cytarabine) and high-dose systemic cytarabin (R-DHAP protocol) the patient lost control of bowel and bladder function and developed an ascending, irreversible paraplegia. Infectious or neoplastic diseases of the spinal cord were ruled out...
June 2016: Journal of Oncology Pharmacy Practice
Olga A Taylor, Marilyn J Hockenberry, Kathy McCarthy, Patricia Gundy, David Montgomery, Adam Ross, Michael E Scheurer, Ida M Moore
Central nervous system (CNS) treatment is an essential part of acute lymphocytic leukemia (ALL) therapy, and the most common CNS treatment is intrathecal (IT) and high-dose intravenous (IV) methotrexate (MTX). Treatment with MTX may cause neurotoxicity, which is often accompanied by neurologic changes, delays in treatment, and prolonged hospital stays. This article reports clinical presentations of 3 patients with severe MTX toxicity as well as levels of oxidative stress and apoptosis biomarkers in cerebrospinal fluid (CSF)...
September 2015: Journal of Pediatric Oncology Nursing: Official Journal of the Association of Pediatric Oncology Nurses
Takuro Nishikawa, Yasuhiro Okamoto, Shinsuke Maruyama, Takayuki Tanabe, Koichiro Kurauchi, Yuichi Kodama, Shunsuke Nakagawa, Yuichi Shinkoda, Yoshifumi Kawano
A four-year-old girl on maintenance therapy for acute lymphoblastic leukemia (ALL) complained of a headache and low back pain on the day she received her 21st intrathecal methotrexate (it-MTX) administration, and the next day experienced numbness and pain in her foot. This numbness gradually spread to her hand. She thereafter developed a fever and was hospitalized on day 8. After antibiotic therapy, the fever disappeared. However, her lower limbs became paralyzed, and she also developed urinary retention. On day 12, her paralysis progressed upwards, and she also developed paralysis of the upper limbs...
November 2014: [Rinshō Ketsueki] the Japanese Journal of Clinical Hematology
Xiang Wang, Ping Liu, Weixiao Yang, Lu Li, Peijing Li, Zheng Liu, Zhongxiong Zhuo, Yunhua Gao
Methotrexate (MTX) is the single most effective agent for the treatment of primary central nervous system lymphoma. Currently, the delivery of MTX to the brain is achieved by high systemic doses, which cause severe long-term neurotoxicity, or intrathecal administration, which is highly invasive and may lead to infections or hemorrhagic complications. Acoustically active microbubbles have been developed as drug carriers for the noninvasive and brain-targeted delivery of therapeutics. However, their application is limited by their low drug-loading capacity...
2014: International Journal of Nanomedicine
Kwai Han Yoo, Ji Yun Lee, Sung Hee Lim, Young Hyeh Ko, Seok Jin Kim, Won Seog Kim
BACKGROUND: The simultaneous presentation of systemic diffuse large B cell lymphoma (DLBCL) with central nervous system (CNS) disease is not well controlled by either R-CHOP or systemic methotrexate (MTX) alone. METHODS: We conducted a pilot trial with 6 patients who were initially diagnosed with systemic DLBCL with CNS involvement. Patients were treated with a systemic MTX plus R-CHOP regimen. RESULTS: The overall response rate was 4/6 (66...
2015: Acta Haematologica
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