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 journalArticlepeer-review

5 Scopus citations


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 languageEnglish (US)
Pages (from-to)165-169
Number of pages5
JournalJournal of Pediatric Hematology/Oncology
Issue number2
StatePublished - Mar 1 1999


  • 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


Dive into the research topics of 'Delayed methotrexate clearance in a patient with sickle cell anemia and osteosarcoma'. Together they form a unique fingerprint.

Cite this