Methotrexate-induced neurotoxicity is a well-defined side-effect of high-dose and intrathecal
methotrexate with characteristic clinico-radiological findings and transient nature. Our experience in managing this entity in children with
acute lymphoblastic leukemia(ALL) is reported here. All children with de novo ALLregistered from January 2016 through December 2021 who developed
methotrexate-induced neurotoxicity were included. Of children with ALL treated during the study period, thirty-three experienced
methotrexate induced neurotoxicity with an incidence of 1.25%.
Stroke-like symptoms(36.36%; 12/33) were the most common clinical manifestation followed by
seizures(30.3%, 10/33). Twenty-three patients had radiological features consistent with
methotrexate-induced
leukoencephalopathy. With emerging evidence, thirty-one patients were re-challenged with
methotrexate (IV/IT), of whom 4 patients had recurrence of symptoms. No long-term neurological sequalae were noted in our cohort, despite rechallenging. Therefore in our study,
methotrexate induced neurotoxicity is a self-limiting toxicity and
methotrexate can be re-challenged safely without compromising theintensity of CNS-directed
therapy.