Intrathecal Leucovorin After Intrathecal Methotrexate Overdose

  title={Intrathecal Leucovorin After Intrathecal Methotrexate Overdose},
  author={Lisa Jardine and Liam Ingram and Werner A. Bleyer},
  journal={Journal of Pediatric Hematology/Oncology},
Purpose: Intrathecal methotrexate is a standard and important therapy in acute leukemia. Unfortunately, overdose is a well reported complication of this therapy. We report a fatal event secondary to intrathecal leucovorin. Patients, Methods, and Results: An 11-year-old boy with a 6-month history of treatment of acute lymphocytic leukemia received an “overdose” of 20 mg of intrathecal methotrexate. He was treated with intrathecal leucovorin and subsequently experienced severe neurotoxicity and… 
Accidental High-dose Intrathecal Treatment: Late Results of a Patient
A nursing error was experienced in which 35 mg of intrathecal methotrexate was administered instead of the planned 12 mg to a 3-year-old boy with T-cell non-Hodgkin lymphoma, stage IV, and his most recent cranial CT and electroencephalography results revealed no sequelae.
Accidental Overdose of Intrathecal Cytarabine in Children
These cases demonstrate that measures such as CSF exchange are not uniformly required for cytarabine overdose, and are demonstrated to be safe and effective in children with cancer.
Successful treatment of intrathecal methotrexate overdose with folinic acid rescue: a case report
The favourable outcome in a 7‐y‐old boy with acute lymphoblastic leukaemia suggests that folinic acid rescue may be adequate to prevent sequelae in patients who undergo intrathecal MTX overdoses up to 300 mg.
Treatment of intrathecal methotrexate overdose with folinic acid rescue and lumbar cerebrospinal fluid exchange: A report of two cases.
The favorable outcome in two male cases of intrathecal methotrexate overdose suggests that CSF exchange is safe and that folinic acid rescue may be adequate to prevent sequelae in patients subjected to intratheCal MTX overdoses up to 120 mg.
Treatment of two cases on the same day of intrathecal methotrexate overdose using cerebrospinal fluid exchange and intrathecal instillation of carboxypeptidase-G2
Three years after the incident, one boy with acute lymphocytic leukemia has no neurological or neuropsychological sequelae after the MTX overdose, while the other reports some loss of short-term memory.
Delayed recognition of intrathecal methotrexate overdose.
Administration of high-dose intrathecal methotrexate may not lead to symptoms, as was the case in a 10-year-old girl diagnosed with B-precursor cell acute lymphoblastic leukemia, but may be related to individual variations in cerebrospinal fluid dynamics and drug metabolism.
Intrathecal methotrexate overdose
Two children with acute lymphoblastic leukaemia and a 4‐y‐old boy with Burkitt's lymphoma who were to receive an intrathecal injection of methotrexate after completion of intravenous metotrexate infusion developed generalized convulsion 3 h after the overdose, but afterwards recovered completely.


Successful treatment of intrathecal methotrexate overdose by using ventriculolumbar perfusion and intrathecal instillation of carboxypeptidase G2.
This is the first reported case of the use of IT instillation of CPDG2 for the treatment of an overdose of IT administered MTX in a human, and it is only the second reported favorable outcome after an IT overdose of more than 500 mg of MTX.
Cerebrospinal fluid exchange after intrathecal methotrexate overdose. A report of two cases
Cerebrospinal fluid exchange is safe and can be recommended in all cases of intrathecal methotrexate overdosage and Ventriculo‐cisternal perfusion is not necessary in cases of a 10‐fold overdose if the patient has no signs of acute neurotoxicity.
Exchange of Cerebrospinal Fluid in Accidental Intrathecal Overdose of Cytarabine
By the exchange of cerebrospinal fluid with isotonic saline started 1 hour after overdose through a lumbar needle, about 27% of the administered dose was recovered, indicating that this procedure is of value in managing patients with heavy overdose of intrathecal cytarabine in hospitals without neurosurgical facilities.
Unexpected acute neurologic toxicity in the treatment of children with acute lymphoblastic leukemia.
These findings suggest that folate replacement due to administration of leucovorin modulated MTX toxicity and/or modified an interaction among VP-16, ARA-C, intrathecal therapy, and the central nervous system.
Pharmacokinetics and biochemical effects of a fatal intrathecal methotrexate overdose
A slightly prolonged CSF methotrexate half‐life suggested a decreased rate of clearance from the CSF, either due to saturation or destruction of the transport mechanisms.
Intrathecal methotrexate-induced neurotoxicities.
The use of intrathecal methotrexate is a reasonably safe and effective chemotherapeutic modality when proper administrative techniques are observed.
Neurotoxicity and elevated cerebrospinal-fluid methotrexate concentration in meningeal leukemia.
Observations suggest that the neurotoxicity associated with intrathecal methotrexate may be associated with prophylaxis or treatment of meningeal leukemia.
Methotrexate. II. Use in pediatric chemotherapy.
  • R. Lippens
  • Medicine
    The American journal of pediatric hematology/oncology
  • 1984
Use of the principle of concentration X time in dosage calculations will result in the avoidance of giving unnecessarily high doses of methotrexate.