Methotrexate (MTX) is a widely used anti-tumor drug, folic acid antagonists. The effectiveness of high doses (more than 1 g/m2) of MTX in a monotherapy or in a combination with other chemotherapeutic drugs has been proven in a treatment of a large spectrum of oncological diseases in children such as osteosarcoma, tumors of the central nervous system, lymphomas, acute lymphoblastic leukemia. The use of high doses of MTX is often fraughted with development of life-threatening complications such as MTX-induced acute kidney injury, neurotoxicity, myelosuppression. Currently developed recommendations for therapeutic monitoring and supportive care, including hyper-hydration, urine alkalization and leucovorin therapy, allow to reduce toxicity of MTX, but in some patients it is not always possible to prevent the development of complications. Cohort studies in order to identify risk factors for toxicity after high doses of MTX in children with different forms of cancer are limited, as well as comparing various types of supportive care regimens, including, infusion therapy. Studying of development mechanisms of MTX toxicity depending on background conditions will allow to improve existing recommendations and develop new and most effective standards of supportive therapy with respect to the individual specifics of patients.
Atypical hemolytic uremic syndrome is a rare disorder uncontrolled complement activation, which is classically manifested by anemia, thrombocytopenia and renal failure. Extrarenal manifestations are observed in 20 % of patients, most of which are associated with damage of the central nervous system. Eculizumab is effective treatment option. The article describes a case report of the severe atypical hemolytic uremic syndrome in a 20 m. o. patient who received immunotherapy with anti-GD2 antibodies (dinutuximab beta) for a high-risk neuroblastoma.
The article presents the case of successful extracorporeal membrane oxygenation in severe acute respiratory distress syndrome in a child with malignant brain tumor. This method can be used in children with oncological diseases, taking into account the underlying disease and risk factors, considering strict implementation of the recommendations on concomitant therapy, laboratory control and monitoring.
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