İrfan YAVAŞOĞLU, Gürhan KADIKÖYLÜ, Zahit BOLAMAN

Megaloblastic anemia due to intrathecal methotrexate

İki yıl once primer mediastinal CD20 pozitif yaygın büyük B hücreli lenfoma tanısı koyduğumuz hasta, R-CHOP kemoterapisi aldı. Kemoterapiden sonra tam yanıt elde ettik. On sekiz ay sonra baş ağrısı, bulantı ve kusma şikayetleri başladı. Kraniyel magnetik görüntülemede kitle tespit edildi. Kraniyel radyoterapi uygulandı. Haftada 2 kez 6 hafta süreyle lumbar yolla 20 mg intratekal methotrexate (MTX) verildi. Intratekal methotrexate kesildikten 10 gün sonra pansitopeni gelişti. Kemik iliği aspirasyon ve biyopsisinde megaloblastik değişiklikler gözlendi. Biyokimyasal değerlerinde folik asid 6.22 ng/ml (N:4.2-19.99) ve kobalamin 803 pg/ ml (N:197-866) idi. Oral folik asit 5 mg/gün baş - landı. Ondördüncü günde hemoglobin 10.2 g/ dl, platelet sayısı 432 000/mm3 ve lökosit sayısı 5100/mm3 idi. Sonuç olarak intratekal methotrexate ile tedavi edilen hastalarda takip ve folik asit profilaksisi düşünülebilir.

İntratekal metotreksata bağlı megaloblastik anemi

We diagnosed to the patient as primary mediastinal CD20 positive diffuse large B-cell lymphoma two years ago. The patient received R-CHOP chemotherapy. Complete remission was obtained from chemotherapy. After 18 months, headache, nausea and vomiting occurred. Cranial magnetic resonance imaging showed mass lesions. Cranial radiotherapy was applied. Then intrathecal methotrexate (MTX) was administered at a dose of 12 mg via lumbar puncture twice weekly for 6 weeks. Pancytopenia was detected after ten days of the discontinuation of intrathecal MTX. There were apparent megaloblastic changes on the bone marrow aspiration and biopsy. The biochemical parameters were folic acid 6.22 ng/ml (N:4.2-19.99) and cobalamin 803 pg/ml (N:197-866). The patient was treated with oral folic acid 5 mg/day. Hematological parameters were hemoglobin 10.2 g/ dl, platelet count 432 000/mm3, and leukocyte count 5100/mm3 at the 14th day. In conclusion, the patients treated with intrathecal MTX should be followed-up and folic acid prophylaxis may be considered.

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