scholarly journals Lesson of the week: Low dose methotrexate and bone marrow suppression

BMJ ◽  
2003 ◽  
Vol 326 (7383) ◽  
pp. 266-267 ◽  
Author(s):  
M. Sosin
Keyword(s):  
Bone Marrow ◽  
Low Dose ◽  
Bone Marrow Suppression ◽  
Dose Methotrexate

scholarly journals Acute Methotrexate Toxicity: A Fatal Condition in Two Cases of Psoriasis

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Pankti Jariwala ◽  
Vinay Kumar ◽  
Khyati Kothari ◽  
Sejal Thakkar ◽  
Dipak Dayabhai Umrigar
Keyword(s):  
Bone Marrow ◽  
Drug Interactions ◽  
Creatinine Level ◽  
Joint Pain ◽  
Low Dose ◽  
Skin Lesions ◽  
Bone Marrow Suppression ◽  
Intermittent Treatment ◽  
Self Medication ◽  
Dose Methotrexate

We describe two fatal cases of low dose methotrexate (MTX) toxicity in patients with psoriasis, emphasizing the factors that exacerbate MTX toxicity. The first patient was a 50-year-old male of psoriasis on intermittent treatment with MTX. After a treatment-free period of six months, he had self-medication of MTX along with analgesic for joint pain for one week which followed ulceration of the lesions, bone marrow suppression, and eventually death. The second patient was a 37-year-old male of psoriasis, who has taken MTX one week earlier without prior investigations. He had painful ulcerated skin lesions and bone marrow suppression. On investigations, he showed high creatinine level and atrophied, nonfunctioning right kidney on ultrasonography. In spite of dialysis, he succumbed to death. MTX is safe and effective if monitored properly, but inadvertent use may lead to even death also. Prior workup and proper counseling regarding the drug interactions as well as self-medication should be enforced.

scholarly journals Acute methotrexate toxicity in psoriasis

2019 ◽  
Vol 5 (3) ◽  
pp. 652
Author(s):  
Peram Karunakar ◽  
Venkateswara Rao Garimella ◽  
Chinmai Yerram ◽  
Anusha Gogula
Keyword(s):  
Bone Marrow ◽  
Plaque Psoriasis ◽  
Low Dose ◽  
Standard Treatment ◽  
Treatment Guidelines ◽  
Psoriasis Patient ◽  
Bone Marrow Suppression ◽  
Chronic Plaque Psoriasis ◽  
Dose Methotrexate ◽  
Standard Treatment Guidelines

<p align="left">We describe two cases of low dose methotrexate (MTX) toxicity in patients with psoriasis. Patient was a 49-year-old male, known case of chronic plaque psoriasis from 10 years on and off. He was advised to take MTX 2.5 mg 2 days a week but patient took 2.5 mg twice daily (BD) for 6 continuous days following which he developed ulceration over psoriatic plaques and bone marrow suppression. MTX is safe and effective if adhered to standard treatment guidelines but inadverent use may lead to it’s toxicity.</p>

scholarly journals Severe bone marrow suppression following single-dose methotrexate treatment for ectopic pregnancy

2017 ◽  
Author(s):  
Betül Dündar ◽  
Burcu Dinçgez Çakmak ◽  
Gülten Özgen ◽  
Fatma Ketenci Gencer ◽  
Burcu Aydın Boyama
Keyword(s):  
Bone Marrow ◽  
Single Dose ◽  
Ectopic Pregnancy ◽  
Bone Marrow Suppression ◽  
Dose Methotrexate ◽  
Methotrexate Treatment

scholarly journals Low Transplant Mortality in Allogeneic Bone Marrow Transplantation for Acute Myeloid Leukemia: A Randomized Study of Low-Dose Cyclosporin Versus Low-Dose Cyclosporin and Low-Dose Methotrexate

Blood ◽  
1998 ◽  
Vol 91 (9) ◽  
pp. 3503-3508 ◽  
Author(s):  
P. Zikos ◽  
M.T. Van Lint ◽  
F. Frassoni ◽  
T. Lamparelli ◽  
F. Gualandi ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Low Dose ◽  
Conditioning Regimen ◽  
Allogeneic Bone ◽  
End Points ◽  
Dose Methotrexate ◽  
Actuarial Risk ◽  
Acute Myeloid

Abstract Sixty patients undergoing allogeneic bone marrow transplant for acute myeloid leukemia (AML) in first remission (CR1; n = 49) or more advanced phase (n = 11) were entered in a prospective trial of graft-versus-host disease (GvHD) prophylaxis: low-dose cyclosporin A (IdCSA; 1 mg/kg/d from day −1 to +20 day; n = 28) or IdCSA plus low-dose methotrexate (IdMTX; 10 mg/m2 for day +1, 8 mg/m2 for days +3, +6, and +11; n = 32). Primary end points were acute GvHD (aGvHD) and transplant-related mortality (TRM); secondary end points were relapse and survival. The conditioning regimen consisted of cyclophosphamide (120 mg/kg) and fractionated total body irradiation (3.3 Gy/d for 3 consecutive days). The actuarial risk of developing aGvHD grade II-III was 61% for IdCSA alone and 34% for IdCSA + IdMTX (P = .02). The actuarial risk of TRM at 1 year was 11% versus 13%, respectively, and older patients (≧29 years) had higher TRM than younger patients (22% v 5%,P = .01). The age effect was significant in the IdCSA group (P = .04) but not in the IdCSA + IdMTX group (P = .1). The median follow-up is 4.4 years, with an overall actuarial survival of 78% for CR1 patients and 36% for patients with advanced disease. For patients in CR1 the outcome of the two regimens was as follows: survival 77% versus 80% (P = .6), relapse 20% versus 9% (P = .1), and TRM 13% versus 17% (P = .6). This study suggests that TRM can be reduced in AML patients undergoing allogeneic marrow transplants with a mild conditioning regimen and low-dose immunosuppression, and this translates in a 78% 5-year survival for CR1 patients. Beyond CR1 the major obstacle remains leukemia relapse, which is not prevented by low-dose in vivo immunosuppression.

scholarly journals CARDIOTOXICITY: AN UNUSUAL CASE OF METHOTREXATE OVERDOSE

2021 ◽  
Vol 9 (01) ◽  
pp. 928-930
Author(s):  
R. Nhiri ◽  
◽  
S.A Maqdouf ◽  
N. Elouafi ◽  
◽  
...  
Keyword(s):  
Bone Marrow ◽  
Low Dose ◽  
Unusual Case ◽  
Bone Marrow Toxicity ◽  
Pyrimidine Synthesis ◽  
Dose Methotrexate ◽  
Small Series ◽  
Oncological Diseases ◽  
Rheumatoid Polyarthritis

The methotrexate (MTX) is an antimetabolite, whose dosages vary according to indication. It is used in the treatment of tumoral pathologies, as acute lymphoblastic leukaemias and, in rheumatology, in the rheumatoid polyarthritis (RP) and other chronic inflammatory rheumatisms The methotrexate belongs to the group of antifolates: it inhibits purine and pyrimidine synthesis, which accounts for its efficacy in the therapy of cancer as well as for some of its toxicities. Relative or absolute overdoses in low-dose methotrexate treatments for non-oncological diseases are regularly reported, either in isolated cases or in small series. The bone marrow toxicity with thrombocytopenia and leuconeutropenia is most often the first sign of general involvement. The cardiotoxicity of methotrexate is very rare, in this article we report the observation of pancytopenia associated with cardiotoxicity in a woman treated for RA, for whom the etiological investigation revealed inadvertent methotrexate intoxication by mistake of dosage.

scholarly journals Low Transplant Mortality in Allogeneic Bone Marrow Transplantation for Acute Myeloid Leukemia: A Randomized Study of Low-Dose Cyclosporin Versus Low-Dose Cyclosporin and Low-Dose Methotrexate

Blood ◽  
1998 ◽  
Vol 91 (9) ◽  
pp. 3503-3508
Author(s):  
P. Zikos ◽  
M.T. Van Lint ◽  
F. Frassoni ◽  
T. Lamparelli ◽  
F. Gualandi ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Low Dose ◽  
Conditioning Regimen ◽  
Allogeneic Bone ◽  
End Points ◽  
Dose Methotrexate ◽  
Actuarial Risk ◽  
Acute Myeloid

Sixty patients undergoing allogeneic bone marrow transplant for acute myeloid leukemia (AML) in first remission (CR1; n = 49) or more advanced phase (n = 11) were entered in a prospective trial of graft-versus-host disease (GvHD) prophylaxis: low-dose cyclosporin A (IdCSA; 1 mg/kg/d from day −1 to +20 day; n = 28) or IdCSA plus low-dose methotrexate (IdMTX; 10 mg/m2 for day +1, 8 mg/m2 for days +3, +6, and +11; n = 32). Primary end points were acute GvHD (aGvHD) and transplant-related mortality (TRM); secondary end points were relapse and survival. The conditioning regimen consisted of cyclophosphamide (120 mg/kg) and fractionated total body irradiation (3.3 Gy/d for 3 consecutive days). The actuarial risk of developing aGvHD grade II-III was 61% for IdCSA alone and 34% for IdCSA + IdMTX (P = .02). The actuarial risk of TRM at 1 year was 11% versus 13%, respectively, and older patients (≧29 years) had higher TRM than younger patients (22% v 5%,P = .01). The age effect was significant in the IdCSA group (P = .04) but not in the IdCSA + IdMTX group (P = .1). The median follow-up is 4.4 years, with an overall actuarial survival of 78% for CR1 patients and 36% for patients with advanced disease. For patients in CR1 the outcome of the two regimens was as follows: survival 77% versus 80% (P = .6), relapse 20% versus 9% (P = .1), and TRM 13% versus 17% (P = .6). This study suggests that TRM can be reduced in AML patients undergoing allogeneic marrow transplants with a mild conditioning regimen and low-dose immunosuppression, and this translates in a 78% 5-year survival for CR1 patients. Beyond CR1 the major obstacle remains leukemia relapse, which is not prevented by low-dose in vivo immunosuppression.

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