Irreversible Intrathecal Chemotherapy-induced Myelopathy in a Patient with Diffuse Large B-cell Lymphoma

Intern Med. 2024 Feb 15;63(4):547-551. doi: 10.2169/internalmedicine.2031-23. Epub 2023 Jun 28.

Abstract

Intrathecal chemotherapy is often administered for prophylaxis and treatment of central nervous system involvement in hematological malignancies. However, it may rarely cause neurotoxicity as a side effect. We herein report a 74-year-old woman with diffuse large B-cell lymphoma including a spinal lesion. She received systemic and intrathecal chemotherapy. After five doses of intrathecal chemotherapy, she developed intrathecal chemotherapy-induced myelopathy. Intrathecal treatment was discontinued, and she was administered vitamin B12 and folic acid, along with steroid pulses. However, her symptoms did not improve. Intrathecal chemotherapy-induced myelopathy is rare, but may be irreversible; therefore, clinicians should be aware of this potential complication.

Keywords: diffuse large B-cell lymphoma; intrathecal chemotherapy; myelopathy.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antineoplastic Agents* / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Bone Marrow Diseases* / drug therapy
  • Female
  • Humans
  • Lymphoma, Large B-Cell, Diffuse* / complications
  • Lymphoma, Large B-Cell, Diffuse* / drug therapy
  • Methotrexate / therapeutic use
  • Spinal Cord Diseases* / chemically induced
  • Spinal Cord Diseases* / diagnostic imaging
  • Spinal Cord Diseases* / drug therapy

Substances

  • Antineoplastic Agents
  • Methotrexate