Progressive ascending paralysis following administration of intrathecal and intravenous cytosine arabinoside. A Pediatric Oncology Group study

Cancer. 1986 Mar 15;57(6):1083-8. doi: 10.1002/1097-0142(19860315)57:6<1083::aid-cncr2820570602>3.0.co;2-b.

Abstract

Two childhood acute myelogenous leukemia (AML) patients receiving intrathecal (IT) and intravenous (IV) cytosine arabinoside (Ara-C) developed progressive ascending paralysis, resulting in death in one patient. Necropsy findings on this patient included spinal cord demyelination characteristic of Ara-C neurotoxicity. An unusual aspect of these two cases was the delay between cessation of IT therapy and the onset of neurologic symptoms. These patients received relatively low total doses of IT Ara-C and standard doses of IV Ara-C. Previous studies have shown that Ara-C equilibrates readily between serum and cerebrospinal fluid; this implies that total IV and IT doses of Ara-C may be additive in relation to development of neurotoxicity. For these reasons, use of IV and IT Ara-C in childhood AML must be approached with greater caution, especially if neurologic abnormalities develop during or after therapy.

Publication types

  • Case Reports
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Adolescent
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Brain / pathology
  • Cytarabine / administration & dosage
  • Cytarabine / adverse effects*
  • Female
  • Humans
  • Injections, Intravenous
  • Injections, Spinal
  • Leukemia, Myeloid, Acute / drug therapy*
  • Leukemia, Myeloid, Acute / radiotherapy
  • Lung / blood supply
  • Lung / pathology
  • Muscles / pathology
  • Paralysis / chemically induced*
  • Paralysis / pathology
  • Spinal Cord / pathology
  • Spinal Cord / ultrastructure
  • Time Factors

Substances

  • Cytarabine