Methotrexate-induced myelopathy responsive to substitution of multiple folate metabolites.
J Neurooncol
; 97(3): 425-7, 2010 May.
Article
en En
| MEDLINE
| ID: mdl-19821069
ABSTRACT
Methotrexate (MTX)-associated myelopathy is a rare but serious subacute complication of MTX-based chemotherapy. We report the case of a woman with breast cancer and meningeal carcinomatosis who developed severe progressive myelopathy after four cycles of intrathecal MTX administration. We substituted high doses of the key metabolites of the methyl-transfer pathway S-adenosylmethionine (SAM), 200 mg three times daily i.v.; folinate, 20 mg four times daily i.v.; cyanocobalamin, 100 microg once daily i.v.; and methionine, 5 g daily p.o. The patient's paraparesis improved rapidly thereafter, and magnetic resonance (MR) imaging showed resolution of the intramedullary lesions. Genetic analyses revealed homozygosity for the A allele of methylenetetrahydrofolate reductase (MTHFR) c.1298A>C (p.E429A), whereas other genetic variants of folate/methionine metabolism associated with MTX neurotoxicity were not present. Substitution with multiple folate metabolites may be a promising strategy for the treatment of MTX-induced neurotoxicity.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Enfermedades de la Médula Espinal
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Complejo Vitamínico B
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Metotrexato
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Metionina
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Antimetabolitos Antineoplásicos
Límite:
Female
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Humans
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Middle aged
Idioma:
En
Revista:
J Neurooncol
Año:
2010
Tipo del documento:
Article
País de afiliación:
Alemania