Transverse myelopathy occurring with intrathecal administration of methotrexate and cytarabine chemotherapy: A case report

Abstract

Abstract. Paraplegia following spinal injury is a rare complication subsequent to the administration of intrathecal chemotherapy; however, it is also one of the rare clinical features of central nervous system leukemia (CNSL). Distinguishing between the two is extremely important. The present study reports the case of a 46-year-old man who was diagnosed with acute lymphoblastic leukemia and subsequently achieved remission in the blood and bone marrow following the initial course of chemotherapy. However, the patient developed a sudden onset of paraplegia and urinary retention due to spinal cord infiltration of leukemia cells following the administration of intrathecal methotrexate and cytarabine. The paraplegia was initially reversible. However, a few weeks later, the patient developed irreversible paraplegia due to a complication of the intrathecal administration of chemotherapy (methotrexate and cytarabine arabinoside). The patient gave up further treatment in

Inadvertent intrathecal administration of daunomycin resulting in fatality: Case report and therapeutic considerations

“…This phenomenon and transverse myelopathy has been reported in similar cases resulting from the inadvertent IT administration of other chemotherapeutic compounds. This includes methotrexate, cytarabine, and most commonly vincristine [ 7 , [14] , [15] , [16] , [17] ]. Since the first reported IT injection of vincristine in 1968, 35 cases have been published; this is thought to be an underestimate, with many more cases going unreported and anecdotal accounts suggesting more than 100 cases [ 7 , 18 ].…”

Intrathecal Methotrexate-Induced Necrotizing Myelopathy: A Case Report and Review of Histologic Features

“…The insufficient CNS accumulation of the drugs conventionally used to treat ALL explains why, in the absence of adequate IT prophylaxis, recurrence at this site is observed in approximately 30% to 50% of adult patients. 2,5 Effective CNS prophylaxis has decreased the incidence of CNS relapse in cases of ALL to 5% to 10%. 6 Unfortunately, systemic and/or IT methotrexate administration is associated with severe neurotoxicity, which can be divided into acute, subacute, and chronic forms based on the time of appearance of symptoms after administration.…”

“…1 Without preventive therapy, 30% to 50% of adults with ALL eventually develop CNS involvement. 2 However, following advances in chemotherapy and effective CNS prophylaxis, the incidence of CNS relapse has decreased to 5% to 10%. 2 Intrathecal (IT) chemotherapy is the preferred method for CNS prophylaxis because it bypasses the blood-brain barrier (BBB) and allows for effective treatment at a lower dose.…”

“…2 However, following advances in chemotherapy and effective CNS prophylaxis, the incidence of CNS relapse has decreased to 5% to 10%. 2 Intrathecal (IT) chemotherapy is the preferred method for CNS prophylaxis because it bypasses the blood-brain barrier (BBB) and allows for effective treatment at a lower dose. The most widely used and effective agent is methotrexate because it persists longer in the cerebrospinal fluid (CSF) and penetrates more deeply into meninges and CNS parenchyma.…”

Addressing BBB Heterogeneity: A New Paradigm for Drug Delivery to Brain Tumors

“…From amongst small molecules, methotrexate and cytarabine are frequently prescribed for IT administration. However, there are numerous reports of neurotoxicity and other complications such as transverse myelopathy associated with the IT administration of these drugs [ 70 , 71 , 72 , 73 , 74 , 75 ]. Therefore, although high concentrations can be attained in the CSF using IT injections, reducing the total dose and risk of systemic toxicity, this method of administration has its drawbacks.…”