Episodes of acute methotrexate-related neurotoxicity linked to compromised long-term neurocognitive function

Pediatr Blood Cancer. 2024 Sep;71(9):e31169. doi: 10.1002/pbc.31169. Epub 2024 Jul 3.

Abstract

Methotrexate is a critical component of curative chemotherapy for pediatric acute lymphoblastic leukemia (ALL), but is associated with neurotoxicity. Information on long-term outcomes following an acute neurotoxic event is limited. Therefore, this report compares neurocognitive performance more than 12 months post diagnosis (mean = 4 years) between ALL patients with (n = 25) and without (n = 146) a history of acute neurotoxicity. Compared to children with no documented on-treatment neurotoxic event, children who experienced a neurotoxic event during treatment exhibited poorer performance on measures of fine motor function (p = .02) and attention (p = .02). Children with ALL who experience acute neurotoxicity may be candidates for early neuropsychological screening and intervention.

Keywords: late effects; leukemia; methotrexate; neurocognition; psychology; toxicity.

MeSH terms

  • Adolescent
  • Antimetabolites, Antineoplastic* / adverse effects
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Methotrexate* / adverse effects
  • Neuropsychological Tests
  • Neurotoxicity Syndromes* / etiology
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma* / drug therapy
  • Prognosis

Substances

  • Methotrexate
  • Antimetabolites, Antineoplastic