levoleucovorin and Mouth-Diseases

Nasal Type T/natural killer (NK)-cell lymphomas are rare clinical entities, highly aggressive with a very poor prognosis. We present a case of a 37-year-old immunocompetent man presenting with deep palatal ulceration and a 3-month history of symptoms, which appear to have been misdiagnosed by physicians. The final diagnosis was achieved by a 15-day diagnostic algorithm, during which time the clinical status of the patient worsened severely. In this article, we also provide a succinct update on the clinical and histopathological findings of Peripheral T/NK-cell lymphomas and propose that symptoms that are consistent with these clinical entities should be considered from the early stages to inform a suitable diagnostic pathway Because of their highly aggressive behavior, we suggest that early therapy of T/NK-cell lymphomas may be started before completing the specific diagnostic investigations.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Chronic Disease; Delayed Diagnosis; Dexamethasone; Diagnostic Errors; Etoposide; Fistula; Humans; Ifosfamide; Leucovorin; Lymphoma, Extranodal NK-T-Cell; Male; Maxillary Sinusitis; Methotrexate; Mouth Diseases; Nose Diseases; Nose Neoplasms; Palatal Neoplasms; Radiotherapy

In the conduct of a clinical trial, unexpectedly high rates of toxicity may cause a researcher to want to terminate the trial early even though no formal stopping rule had been specified. The experience of one such clinical trial is used as an example of the ways in which group sequential methodology can be applied in deciding to stop the study, as well as in reporting the results of the clinical trial. This approach is then compared to a Bayesian analysis.

Topics: Antidotes; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Biometry; Clinical Trials as Topic; Fluorouracil; Granulocyte Colony-Stimulating Factor; Humans; Incidence; Leucovorin; Leukopenia; Mathematics; Models, Statistical; Mouth Diseases; Mouth Mucosa; Neoplasms; Research Design

Mucositis is one of the major problems encountered after the administration of systemic chemotherapy. Leucovorin, routinely used as a rescue agent for methotrexate may reduce toxicity, but may also reduce the effectiveness of the chemotherapeutic agent. If leucovorin is administered as a mouth wash, local toxicity may be reduced without loss of methotrexate efficacy. In order to study this, 15 normal human volunteers were given leucovorin mouth wash and then had plasma determinations of 5-methyl-tetrahydrofolate and citrovorum factor. Small but statistically significant increases in plasma levels of 5-methyl-tetrahydrofolate were observed with no increase in levels of plasma citrovorum factor. It is concluded therefore that a small amount of leucovorin is absorbed systemically when administered as a mouth wash, but such an amount would most likely not be significant enough to reduce the effect of methotrexate therapy, but may reduce mucositis.

Topics: Absorption; Administration, Oral; Adult; Female; Humans; Leucovorin; Male; Middle Aged; Mouth Diseases; Mouthwashes

A case of severe oral ulceration, following administration of combination chemotherapy which included methotrexate, is reported. Topically applied folinic acid was effective in facilitating resolution of the oral lesions.

Topics: Administration, Topical; Carcinoma, Squamous Cell; Humans; Leucovorin; Male; Methotrexate; Middle Aged; Mouth Diseases; Mouth Neoplasms; Ulcer

The results of treating 59 patients with advanced carcinoma of the cervix with Adriamycin and methotrexate are given. Five combinations of the two cytotoxic drugs have been evaluated, differing only with regard to the methotrexate. One particular regimen has been shown to be effective with a relatively high remission rate coupled with a low rate of side effects.

Topics: Alopecia; Doxorubicin; Drug Administration Schedule; Drug Therapy, Combination; Female; Gastrointestinal Diseases; Humans; Leucovorin; Leukopenia; Methotrexate; Mouth Diseases; Remission, Spontaneous; Taste Disorders; Ulcer; Uterine Cervical Neoplasms

Topics: Anemia, Hypochromic; Chemical and Drug Induced Liver Injury; Chromosome Aberrations; Chromosome Disorders; Drug Eruptions; Folic Acid Antagonists; Headache; Humans; Leucovorin; Methotrexate; Mouth Diseases; Mouth Mucosa; Nausea; Psoriasis; Vertigo