Abstract
We diagnosed to the patient as primary mediastinal CD20 positive diffuse large B-cell lymphoma two years ago. The patient received R-CHOP chemotherapy. Complete remission was obtained from chemotherapy. After 18 months, headache, nausea and vomiting occurred. Cranial magnetic resonance imaging showed mass lesions. Cranial radiotherapy was applied. Then intrathecal methotrexate (MTX) was administered at a dose of 12 mg via lumbar puncture twice weekly for 6 weeks. Pancytopenia was detected after ten days of the discontinuation of intrathecal MTX. There were apparent megaloblastic changes on the bone marrow aspiration and biopsy. The biochemical parameters were folic acid 6.22 ng/ml (N:4.2-19.99) and cobalamin 803 pg/ml (N:197-866). The patient was treated with oral folic acid 5 mg/day. Hematological parameters were hemoglobin 10.2 g/ dl, platelet count 432 000/mm3, and leukocyte count 5100/mm3 at the 14th day. In conclusion, the patients treated with intrathecal MTX should be followed-up and folic acid prophylaxis may be considered. İki yıl once primer mediastinal CD20 pozitif yaygın büyük B hücreli lenfoma tanısı koyduğumuz hasta, R-CHOP kemoterapisi aldı. Kemoterapiden sonra tam yanıt elde ettik. On sekiz ay sonra baş ağrısı, bulantı ve kusma şikayetleri başladı. Kraniyel magnetik görüntülemede kitle tespit edildi. Kraniyel radyoterapi uygulandı. Haftada 2 kez 6 hafta süreyle lumbar yolla 20 mg intratekal methotrexate (MTX) verildi. Intratekal methotrexate kesildikten 10 gün sonra pansitopeni gelişti. Kemik iliği aspirasyon ve biyopsisinde megaloblastik değişiklikler gözlendi. Biyokimyasal değerlerinde folik asid 6.22 ng/ml (N:4.2-19.99) ve kobalamin 803 pg/ ml (N:197-866) idi. Oral folik asit 5 mg/gün baş - landı. Ondördüncü günde hemoglobin 10.2 g/ dl, platelet sayısı 432 000/mm3ve lökosit sayısı 5100/mm3 idi. Sonuç olarak intratekal methotrexate ile tedavi edilen hastalarda takip ve folik asit profilaksisi düşünülebilir.
References
- Wickramasinghe SN. Diagnosis of megaloblastic anaemias. Blood Rev 2006;20:299-318.
- Sallah S, Hanrahan LR, Phillips DL. Intrathecal methotrex- ate-induced megaloblastic anemia in patients with acute leukemia. Arch Pathol Lab Med 1999;123:774-7.
- Calvert H. Folate status and the safety profile of antifolates. Semin Oncol 2002;29(2 Suppl 5):3-7.
- Cheung CW, Burton C, Smith P, Linch DC, Hoskin PJ, Ardeshna KM. Central nervous system chemoprophylaxis in non-Hodgkin lymphoma: current practice in the UK. Br J Haematol 2005;131:193-200.
- Batchelor T, Loeffler JS. Primary CNS lymphoma. J Clin Oncol 2006;24:1281-8.
- Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239-45.
- Bleyer WA, Nelson JA, Kamen BA. Accumulation of metho- trexate in systemic tissues after intrathecal administration. J Pediatr Hematol Oncol 1997;19:530-2.
- Jacobs SA, Bleyer WA, Chabner BA, Johns DG. Letter: Altered plasma pharmacokinetics of methotrexate adminis- tered intrathecally. Lancet 1975;1:465-6.
- Cohen PR, Schulze KE, Nelson BR. Pancytopenia after a single intradermal infiltration of methotrexate. J Drugs Dermatol 2005;4:648-51.
- Kamen BA, Moulder JE, Kun LE, Ring BJ, Adams SM, Fish BL, et al. Effects of single-dose and fractionated cranial irra- diation on rat brain accumulation of methotrexate. Cancer Res 1984;44:5092-4.
Abstract
İki yıl once primer mediastinal CD20 pozitif yaygın büyük B hücreli lenfoma tanısı koyduğumuz hasta, R-CHOP kemoterapisi aldı. Kemoterapiden sonra tam yanıt elde ettik. On sekiz ay sonra baş ağrısı, bulantı ve kusma şikayetleri başladı. Kraniyel magnetik görüntülemede kitle tespit edildi. Kraniyel radyoterapi uygulandı. Haftada 2 kez 6 hafta süreyle lumbar yolla 20 mg intratekal methotrexate (MTX) verildi. Intratekal methotrexate kesildikten 10 gün sonra pansitopeni gelişti. Kemik iliği aspirasyon ve biyopsisinde megaloblastik değişiklikler gözlendi. Biyokimyasal değerlerinde folik asid 6.22 ng/ml (N:4.2-19.99) ve kobalamin 803 pg/ ml (N:197-866) idi. Oral folik asit 5 mg/gün baş - landı. Ondördüncü günde hemoglobin 10.2 g/ dl, platelet sayısı 432 000/mm3 ve lökosit sayısı 5100/mm3 idi. Sonuç olarak intratekal methotrexate ile tedavi edilen hastalarda takip ve folik asit profilaksisi düşünülebilir.
References
- Wickramasinghe SN. Diagnosis of megaloblastic anaemias. Blood Rev 2006;20:299-318.
- Sallah S, Hanrahan LR, Phillips DL. Intrathecal methotrex- ate-induced megaloblastic anemia in patients with acute leukemia. Arch Pathol Lab Med 1999;123:774-7.
- Calvert H. Folate status and the safety profile of antifolates. Semin Oncol 2002;29(2 Suppl 5):3-7.
- Cheung CW, Burton C, Smith P, Linch DC, Hoskin PJ, Ardeshna KM. Central nervous system chemoprophylaxis in non-Hodgkin lymphoma: current practice in the UK. Br J Haematol 2005;131:193-200.
- Batchelor T, Loeffler JS. Primary CNS lymphoma. J Clin Oncol 2006;24:1281-8.
- Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239-45.
- Bleyer WA, Nelson JA, Kamen BA. Accumulation of metho- trexate in systemic tissues after intrathecal administration. J Pediatr Hematol Oncol 1997;19:530-2.
- Jacobs SA, Bleyer WA, Chabner BA, Johns DG. Letter: Altered plasma pharmacokinetics of methotrexate adminis- tered intrathecally. Lancet 1975;1:465-6.
- Cohen PR, Schulze KE, Nelson BR. Pancytopenia after a single intradermal infiltration of methotrexate. J Drugs Dermatol 2005;4:648-51.
- Kamen BA, Moulder JE, Kun LE, Ring BJ, Adams SM, Fish BL, et al. Effects of single-dose and fractionated cranial irra- diation on rat brain accumulation of methotrexate. Cancer Res 1984;44:5092-4.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Articles |
| Authors | |
| Publication Date | April 1, 2010 |
| Published in Issue | Year 2010 |