J Korean Neurosurg Soc.  2011 Oct;50(4):304-310. 10.3340/jkns.2011.50.4.304.

Leukoencephalopathy and Disseminated Necrotizing Leukoencephalopathy Following Intrathecal Methotrexate Chemotherapy and Radiation Therapy for Central Nerve System Lymphoma or Leukemia

• Kim JY
• Kim ST
• Nam DH
• Lee JI
• Park K
• Kong DS

• KMID: 2190387
• DOI: http://doi.org/10.3340/jkns.2011.50.4.304

Abstract

OBJECTIVE
Intrathecal methotrexate (MTX) therapy combined with whole brain radiotherapy (WBRT) is one of the major treatment modalities for leukemia and lymphoma involving the central nervous system (CNS). The purpose of this study was to retrospectively determine the incidences of leukoencephalopathy and disseminated necrotizing leukoencephalopathy (DNL) following intrathecal MTX therapy for CNS lymphoma or leukemia and to assess the potential risk factors.
METHODS
Between January 2000 and August 2009, 143 patients with CNS lymphoma or leukemia received intrathecal MTX therapy alone or in combination with WBRT at a single institution. Patients were followed up clinically and radiologically at regular two- or three-month intervals. Medical records were reviewed to obtain information regarding the patients' demographics, medical histories, radiologic characteristics, treatments, and clinical courses.
RESULTS
On follow-up MR images, leukoencephalopathy was found in 95 of 143 patients (66.4%). The median time to develop leukoencephalopathy was 6.6 months. Among those with leukoencephalopathy, four patients showed seven extensive white-matter changes with strongly enhancing lesions demonstrating DNL. Histological confirmation was done in six lesions of three patients and radiological diagnosis alone in one patient. Four lesions spontaneously disappeared on MR images without any treatment, with a mean duration of 14 months before disappearance of DNL.
CONCLUSION
Leukoencephalopathy is a common phenomenon that occurs following intrathecal MTX therapy; however, DNL occurs at a very low incidence. For newly developed enhancing lesions, consideration for the occurrence of DNL should be taken to avoid unnecessary invasive procedures or therapies.

Keyword

Leukoencephalopathy; Methotrexate; Intrathecal; Lymphoma; Leukemia

MeSH Terms

Brain
Central Nervous System
Demography
Follow-Up Studies
Humans
Incidence
Leukemia
Leukoencephalopathies
Lymphoma
Medical Records
Methotrexate
Retrospective Studies
Methotrexate