2017 Volume 54 Issue 5 Pages 403-407
High-dose intravenous methotrexate (HD-MTX) and intrathecal MTX, a necessary component for chemotherapy of childhood acute lymphoblastic leukemia (ALL), can cause long-term neurotoxicity, including leukoencephalopathy, which adversely impacts intellectual function. We report the results of a prospective longitudinal examination of cognitive function in a 4-year-old girl at diagnosis treated with HD-MTX intravenous chemotherapy. She achieved normal developmental milestones before her diagnosis of ALL. She lives with her parents who have average socio-economic status. After the diagnosis, she received treatment according to the JACLS ALL-02 SR protocol, which included HD-MTX 3 g/m2×2 courses and IT MTX×12 times. She underwent WISC-IV testing before and three times after the completion of standard-risk ALL therapy over a period of three years. Testing results demonstrated the preservation of fluid (reasoning) ability and crystalized (knowledge) ability, although the scores of working memory declined. General intellectual ability remained within the average range over time. Thus, no neurocognitive deficits were detected in this case within three years after HD-MTX. A prospective study of additional cases is planned to confirm these results.
