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Baseline Characteristics of Patients by Actual Treatment GroupsĮTable 3. CSM-S Trial Enrollment by Site and StrategyĮTable 2.
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Circles represent more extreme values.ĮTable 1. The upper whisker is the largest value that is less than or equal to the third quartile plus 1.5 times the IQR, and the lower whisker is the smallest value that is greater than or equal to the first quartile minus 1.5 times the IQR. Box plots represent the distribution of SF-36 PCS scores: the center line of the box is the median, with the box tops and bottoms indicating the interquartile range (IQR). B, Trajectory of change in SF-36 PCS score by randomized group, with box plots showing distribution of change in SF-36 PCS scores at each time point.
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The 1-year mean change from baseline in the SF-36 PCS score was 6.2 (SD, 10.2) points for dorsal surgery and 5.9 (SD, 8.2) points for ventral surgery. At baseline, mean SF-36 PCS scores for the dorsal and ventral groups were 37.3 (SD, 9.9) and 37.4 (SD, 8.8) points, respectively. Each bar extends from a patient’s baseline score to their 1-year score, with patients in each group ordered by baseline score. A, Change in Short Form 36 physical component summary (SF-36 PCS) score for each patient in the trial from baseline to 1 year. DSEPs more accurately reflected the clinical level of spinal cord dysfunction.Ĭhemotherapy, Intrathecal injections, Leukemia, Myelopathy, Spinal cord injuries, Somatosensory-evoked potential.MCID indicates minimum clinically important difference. The MRI abnormalities were initially absent, but evolved to consist of multi-level spinal cord T2 and STIR hyperintensity with regional gadolinium enhancement. Preferential and persistent dorsal column myelopathy is a distinctive clinical and radiographic presentation of a rare complication of intrathecal chemotherapy. An empiric trial of high-dose intravenous corticosteroids during inpatient rehabilitation more than 6 weeks later produced no significant clinical improvement. Dermatomal somatosensory-evoked potential (DSEP) conduction abnormalities were consistent with thoracic myelopathy. However, repeat imaging at 6 weeks showed abnormal signal in the posterior cord with sparing of the anterior and lateral columns, diffusely involving the lower cervical cord through the conus medullaris. Initial thoracic and lumbar spine magnetic resonance imaging (MRI) at 1 week revealed no abnormalities. Clinical examination showed profound loss of lower limb proprioception and light touch sensation below T5, mild proximal limb weakness, but preserved pinprick and temperature sensation with intact bowel and bladder function. Within 24 hours of an injection of intrathecal methotrexate, cytarabine, and hydrocortisone, the patient developed ascending lower limb numbness and balance difficulties progressing to the inability to ambulate. We present a 42-year-old female with T-cell ALL who developed a myelopathy primarily involving the dorsal columns. Myelopathy is a rare complication of intrathecal chemotherapy used in the treatment of acute lymphoblastic leukemia (ALL). OBJECTIVE/CONTEXT: To describe a distinctive clinical and radiographic pattern of myelopathy following intrathecal chemotherapy.