Role of Diffusion Weighted Imaging in Methotrexate-Induced Leukoencephalopathy in Adult Acute Lymphoblastic Leukaemia Patients

Abstract

BACKGROUND Methotrexate (MTX) is a chemotherapeutic agent commonly used in haematological malignancy. Its complication in childhood Acute Lymphoblastic Leukaemia (ALL) is well known to cause leukoencephalopathy. However, its complications in adults are uncommon. High doses of MTX is used to prevent CNS recurrence and haematological relapse. Diffusion weighted magnetic resonance imaging (DWI) plays an important role in early diagnosis. Aim of our study was to evaluate role of diffusion weighted MR imaging in Methotrexate-induced Leukoencephalopathy in adult acute lymphoblastic Leukaemia patients. METHODS A hospital based cross-sectional retrospective study was conducted. The study group comprised of 7 adult acute lymphoblastic leukaemia (ALL) patients presenting to the Departments of Radio-diagnosis, Medicine and Radiotherapy in a tertiary care hospital from April 2012 to May 2015. RESULTS In our study, 7 adult patients of acute lymphoblastic leukaemia (ALL), four patients (57.1%) developed MTX toxicity in interim maintenance phase and 3 patients (42.9%) developed in second maintenance phase of multidrug BFM-95 Regimen. Diffusion weighted images showed patchy multifocal restriction in 2 patients (28.6%) of acute MTX neurotoxicity and no diffusion restriction in rest 5 patients (71.4%). Acute MTX neurotoxicity in two patients (28.6%) had low apparent diffusion coefficient (ADC) value while 3 patients (42.9%) of chronic MTX neurotoxicity had high ADC value and 2 patients (28.6%) of subacute MTX neurotoxicity had normal ADC value. CONCLUSIONS Prompt recognition of MTX neurotoxicity with diffusion weighted imaging and ADC value are essential to institute early treatment to improve the outcome after MTX overdose in adult ALL patients.

The Relationship of Polymorphism of RFC-I Gene on Methotrexate Serum Level and Related Toxicity in Pediatric Acute Lymphoblastic Leukemia

“…The rate and severity of toxic effects are related to age, sex, race and patient's pharmacogenetics [2]. Methotrexate (MTX) is an important agent in regimens become candidate for consolidation therapy in children suffering from ALL [3,4].…”