Hi Shai,
I would be more suspicious of the intrathecal methotrexate as it has been
associated with leukoencephalopathic changes with ataxia as a presenting
symptom. I have had a handful of pediatric patients with ataxic presentation
from intrathecal methotrexate and also cytarabine.
-Kelly Rock
From: aptaoncology-bounce@xxxxxxxxxxxxx <aptaoncology-bounce@xxxxxxxxxxxxx> On
Behalf Of Shai Sewell
Sent: Tuesday, July 19, 2022 2:14 PM
To: aptaoncology@xxxxxxxxxxxxx; aptaoncpeds@xxxxxxxxxxxxx
Subject: [aptaoncology] Ataxia with ALL
Good afternoon everyone. Hoping people could shed some insight on a case.
I currently have a 25 y.o. male with a PMHx of ALL with CNS involvement,
currently being treated with ponatinib daily, intrathecal methotrexate via
ommaya reservoir, and periodic IV Vincristine. He is being evaluated for ataxic
gait and paresthesias of the lower extremities. Neuro is relating the temporal
dose of his vincristine (last given on 6/22) and his current symptoms (which
started around 07/04) to his symptoms. He was hypoactive on his reflexes (both
upper and lower) as well (1+). He was cleared from CNS involvement in March,
but I am sure they will retest with an LP with these symptoms. I don't have
much experience with ALL or Vincristine, but these symptoms seem odd with such
a sudden onset. Any thoughts on whether this is common with Vincristine,
something else, or if it is more likely due to recurrence?
Thanks in advance,
Shai Sewell
