Transverse Myelitis and Guillain–Barré Syndrome in Pediatric Lymphoid Malignancies: An International Retrospective Study

Central and peripheral neurotoxicity after methotrexate is a rare but challenging complication of therapy for pediatric lymphoid malignancies. In this Ponte-di-Legno Toxicity Working Group and international Berlin-Frankfurt-Münster Group study, we describe nine children and adolescents with transverse myelitis (n = 6) or Guillain-Barré syndrome (n = 3) after chemotherapy that included methotrexate. All transverse myelitis cases but one occurred in lymphoma patients with central nervous system status 3-disease, and early imaging and cerebrospinal fluid findings frequently failed to distinguish the two entities. Three patients died from the toxicity, and all survivors of transverse myelitis had permanent deficits. Re-exposure to intrathecal chemotherapy produced more severe recurrences and should therefore be avoided.