The Treatment Of Acute Lymphocytic Leukemia Discussion
> Methotrexate is used in cancer treatment i.e., chemotherapy drug.
> In this case, it is used for the treatment of acute lymphocytic leukemia (ALL).
MECHANISM OF ACTION
> Methotrexate helps in the cancer treatment by stopping the development of mutated DNA in the cancer cells that is proliferating inside the patients body.
> This drug blocks the action of dihydrofolate reductase (DHFR) enzyme since DHFR is an essential enzyme for the synthesis of DNA.
By blocking the action of DHFR,it effectively slows down the process of growth and spread of cancer cells.
> Most serious complication is methotrexate toxicity.
> Methotrexate is a non-selective chemotherapic drug, thus it also decreases the effectiveness of the patient’s own immune system(Immunosuppresant)
> Life threatening complications such as hepatotoxicity, kidney damage, pulmonary damage, myelosuppression, severe ulcers and skin reactions can be seen in methotrexate toxicity. The Treatment Of Acute Lymphocytic Leukemia Discussion
In this case, high doses of methotrexate were administered to a young patient which lead to the serious methotrexate toxicity.
Patient is experiencing symptoms related to methotrexate toxicity.
> Fever, malaise, blood in urine and stool, skin rash, breathing difficulties, other bacterial infections due to lowered effectiveness of patient’s immune system – all of these are happening because of methotrexate toxicity.
> Patient is experiencing severe adverse effects and requires immediate medial intervention and hospitalisation.
> Treatment includes
* IV fluids
* Leucovorin therapy
* Alkalinization of urine by sodium bicarbonate.
> This treatment is called as LEUCOVORIN RESCUE THERAPY.
> Leucovorin is used to treat methotrexate toxicity because it inhibits the action of DHFR enzyme thus effectively reduces the adverse effects.
> Glucoparidase administration, urine alkalization along with leucovorin therapy and gastric lavage effectively helps in treating methotrexate toxicity.
> High doses of methotrexate resulted in methotrexate toxicity which can be confirmed by analysing the symptoms experienced by the patient.
> Leucovorin rescue therapy is used for effective treatment of methotrexate toxicity. The Treatment Of Acute Lymphocytic Leukemia Discussion