Decrease in cerebral metabolic rate of glucose after high-dose methotrexate in childhood acute lymphocytic leukemia

doi:10.1016/0887-8994(90)90021-R

Pediatric Neurology

Volume 6, Issue 5, September–October 1990, Pages 303-306

https://doi.org/10.1016/0887-8994(90)90021-R Get rights and content

Abstract

We measured changes in the regional cerebral metabolic rate of glucose (rCMRGlu) using ¹⁸F-fluorodeoxyglucose and positron emission tomography for the assessment of neurotoxicity in childhood acute lymphocytic leukemia treated with high-dose methotrexate (HD-MTX) therapy. We studied 8 children with acute lymphocytic leukemia (mean age: 9.6 years) treated with HD-MTX (200 mg/kg or 2,000 mg/M²) therapy. CMRGlu after HD-MTX therapy was most reduced (40%) in the patient who had central nervous system leukemia and was treated with the largest total doses of both intrathecal MTX (IT-MTX) and HD-MTX. CMRGlu in the whole brain after HD-MTX therapy was reduced by an average of 21% (P < 0.05). The reductions of CMRGlu in 8 patients were correlated with total doses of both IT-MTX (r = 0.717; P < 0.05) and systemic HD-MTX (r = 0.784; P < 0.05). CMRGlu of the cerebral cortex, especially the frontal and occipital cortex, was reduced more noticeably than that of the basal ganglia and white matter. We suggest that the measurement of changes in rCMRGlu after HD-MTX therapy is useful for detecting accumulated MTX neurotoxicity.

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Citation Excerpt :
A few case reports documented that FDG-PET or PET/CT may have a role in evaluation of fever of unknown origin in children with cancer, including a case report of a child with AML.25,26 There are a few number of reports regarding the use of FDG-PET for identification and assessment of neurotoxicity of chemotherapy and cranial radiation treatment in childhood ALL.27,28 Komatsu et al.27 suggested that changes in regional cerebral metabolic rate of glucose measured with FDG-PET are useful for detecting accumulated methotrexate (MTX) neurotoxicity.
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Original articleDecrease in cerebral metabolic rate of glucose after high-dose methotrexate in childhood acute lymphocytic leukemia

Abstract

High dose systemic methotrexate-associated acute neurologic dysfunction

Med Pediatr Oncol

Brain stem necrosis after preradiation high-dose methotrexate

Childs Nerv Syst

High-dose methotrexate-induced neurotoxicity associated with elevation of CSF myelin basic protein

J Clin Oncol

Transient encephalopathy after local application of methotrexate

Neuroradiology

Methotrexate leukoencephalopathy mimicking cerebral abscess on CT brain scan

Childs Nerv Syst

Leukoencephalopathy after prophylactic radiation for leukemia in ataxia telangiectasia

Arch Dis Child

Acute fever and delayed leukoencephalopathy following low dose intraventricular methotrexate

J Neurol Neurosurg Psychiatry

Disseminated necrotizing encephalopathy induced by methotrexate alone

Acta Pathol Jpn

Original article
Decrease in cerebral metabolic rate of glucose after high-dose methotrexate in childhood acute lymphocytic leukemia