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LETTER TO EDITOR
Year : 2019  |  Volume : 2  |  Issue : 2  |  Page : 264

Author reply to: Tandon N., et al. and Majumdar S, et al.


Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India

Date of Web Publication20-Dec-2019

Correspondence Address:
Hasmukh Jain
Tata Memorial Centre, Homi Bhabha National Institute, Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_96_19

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How to cite this article:
Jain H, Mahajan A, Phatak V. Author reply to: Tandon N., et al. and Majumdar S, et al. Cancer Res Stat Treat 2019;2:264

How to cite this URL:
Jain H, Mahajan A, Phatak V. Author reply to: Tandon N., et al. and Majumdar S, et al. Cancer Res Stat Treat [serial online] 2019 [cited 2020 Feb 28];2:264. Available from: http://www.crstonline.com/text.asp?2019/2/2/264/273709



In reply to Tandon et al.,[1] we agree with the comment that the diagnosis of methotrexate (MTX)-induced leukoencephalopathy is based on clinicoradiological features. The presence of the 'panda eye' sign is helpful in the appropriate clinical context.[2] The median dose of MTX administered to the patients was 3 g/m2, and the toxicity was seen after a median of two cycles. These patients had received a median of six doses of intrathecal MTX before their presentation with leukoencephalopathy. We agree that this finding needs to be prospectively validated in a multicenter setting.[3]

In reply to Majumdar et al.,[4] we agree with the comment that the appropriate 'high dose' has not been defined. It remains to be seen if the neurotoxicity will reduce at lower doses, because there are multiple reasons for encephalopathy. In addition, an increased risk of relapse will not be acceptable in a curative setting. The 6% incidence is high for neurotoxicity, but is mostly reversible.

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Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tandon N, Khanderia M, Devadas SK. Panda eye sign on diffusion weighted- MRI for the diagnosis of methotrexate-induced subacute leukoencephalopathy. Cancer Res Stat Treat 2019;2:263-4.  Back to cited text no. 1
  [Full text]  
2.
Mahajan A, Jain H, Simha V, Vaidya T, Santhosh Kumar GV, Gupta A, et al. Clinical-radiological features of methotrexate-induced subacute leukoencephalopathy in patients with acute lymphoblastic leukemia: “Panda eye sign” on diffusion weighted-magnetic resonance imaging. Cancer Res Stat Treat 2019;2:28-33.  Back to cited text no. 2
  [Full text]  
3.
Noronha V. Making a case for cancer research in India. Cancer Res Stat Treat 2018;1:71-4.  Back to cited text no. 3
  [Full text]  
4.
Majumdar S, Goli VB, Thorat J. Methotrexate leukoencephalopathy. Cancer Res Stat Treat 2019;2:261-2.  Back to cited text no. 4
  [Full text]  




 

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