Escalated doses of methotrexate and L‐asparaginase in critically ill children with a concurrent diagnosis of acute lymphoblastic leukemia and appendicitis

Abstract

Abdominal complications in pediatric patients with hemato-oncology diseases (HOD) often present with atypical symptoms, resulting in a diagnostic and therapeutic challenge. 1,2 There are no consensus guidelines for the optimal management of a child with neutropenic appendicitis. Delaying or stopping chemotherapy is controversial, especially in newly diagnosed patients with HOD. [3][4][5][6] We present three cases of children simultaneously diagnosed with acute lymphoblastic leukemia (ALL) and complicated appendicitis.They were managed with appendectomy, and less toxic chemotherapy consisted of L-asparaginase 6000 IU/m 2 and escalating doses of methotrexate (50-200 mg/m 2 ) in 10 days intervals 7 (Table 1).