Delayed methotrexate clearance in a patient with sickle cell anemia and osteosarcoma

Elpis Mantadakis; Zora R. Rogers; Angela K. Smith; Raymond Quigley; Arleen F. Ratliff; Barton A. Kamen

doi:10.1097/00043426-199903000-00016

Delayed methotrexate clearance in a patient with sickle cell anemia and osteosarcoma

Elpis Mantadakis, Zora R. Rogers, Angela K. Smith, Raymond Quigley, Arleen F. Ratliff, Barton A. Kamen

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

A 15-year-old girl with homozygous sickle cell anemia (HbSS) and osteosarcoma is described. Delayed clearance of methotrexate (MTX) after the second course of high-dose MTX (HDMTX) led to the development of renal and hepatic toxicities. Rescue was accomplished with high-dose leucovorin, intravenous carboxypeptidase G2, and thymidine. Although the renal and hepatic abnormalities resolved, focal tonic-clonic seizures developed, accompanied by abnormal brain imaging. Four weeks after this episode, all clinical and biochemical abnormalities resolved. Preexistent end-organ damage associated with HbSS may compromise the ability to deliver high-dose chemotherapy with curative intent in patients with malignant disease.

Original language	English (US)
Pages (from-to)	165-169
Number of pages	5
Journal	Journal of Pediatric Hematology/Oncology
Volume	21
Issue number	2
DOIs	https://doi.org/10.1097/00043426-199903000-00016
State	Published - Mar 1 1999

Keywords

Carboxypeptidase G2
Hepatotoxicity
Leucovorin
Methotrexate rescue
Neurologic toxicity
Osteosarcoma
Renal failure
Sickle cell anemia
Thymidine

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Hematology
Oncology

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10.1097/00043426-199903000-00016

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title = "Delayed methotrexate clearance in a patient with sickle cell anemia and osteosarcoma",

abstract = "A 15-year-old girl with homozygous sickle cell anemia (HbSS) and osteosarcoma is described. Delayed clearance of methotrexate (MTX) after the second course of high-dose MTX (HDMTX) led to the development of renal and hepatic toxicities. Rescue was accomplished with high-dose leucovorin, intravenous carboxypeptidase G2, and thymidine. Although the renal and hepatic abnormalities resolved, focal tonic-clonic seizures developed, accompanied by abnormal brain imaging. Four weeks after this episode, all clinical and biochemical abnormalities resolved. Preexistent end-organ damage associated with HbSS may compromise the ability to deliver high-dose chemotherapy with curative intent in patients with malignant disease.",

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AU - Mantadakis, Elpis

AU - Rogers, Zora R.

AU - Smith, Angela K.

AU - Quigley, Raymond

AU - Ratliff, Arleen F.

AU - Kamen, Barton A.

PY - 1999/3/1

Y1 - 1999/3/1

N2 - A 15-year-old girl with homozygous sickle cell anemia (HbSS) and osteosarcoma is described. Delayed clearance of methotrexate (MTX) after the second course of high-dose MTX (HDMTX) led to the development of renal and hepatic toxicities. Rescue was accomplished with high-dose leucovorin, intravenous carboxypeptidase G2, and thymidine. Although the renal and hepatic abnormalities resolved, focal tonic-clonic seizures developed, accompanied by abnormal brain imaging. Four weeks after this episode, all clinical and biochemical abnormalities resolved. Preexistent end-organ damage associated with HbSS may compromise the ability to deliver high-dose chemotherapy with curative intent in patients with malignant disease.

AB - A 15-year-old girl with homozygous sickle cell anemia (HbSS) and osteosarcoma is described. Delayed clearance of methotrexate (MTX) after the second course of high-dose MTX (HDMTX) led to the development of renal and hepatic toxicities. Rescue was accomplished with high-dose leucovorin, intravenous carboxypeptidase G2, and thymidine. Although the renal and hepatic abnormalities resolved, focal tonic-clonic seizures developed, accompanied by abnormal brain imaging. Four weeks after this episode, all clinical and biochemical abnormalities resolved. Preexistent end-organ damage associated with HbSS may compromise the ability to deliver high-dose chemotherapy with curative intent in patients with malignant disease.

KW - Carboxypeptidase G2

KW - Hepatotoxicity

KW - Leucovorin

KW - Methotrexate rescue

KW - Neurologic toxicity

KW - Osteosarcoma

KW - Renal failure

KW - Sickle cell anemia

KW - Thymidine

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Delayed methotrexate clearance in a patient with sickle cell anemia and osteosarcoma

Abstract

Keywords

ASJC Scopus subject areas

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