High-dose cytarabine-associated cerebellar toxicity: A case report

Abstract

High-dose arabinoside cytarabine is used as an effective regimen for post-remission acute leukemia and refractory leukemia treatment. Most commonly used regimen is 3 g/m 2 IV over 1-3 h q12 h for a total of 8-12 doses. Major toxic effects associated with cytarabine are related to bone marrow, gastrointestinal tract, and nervous system. Acute cerebellar toxicity with ataxia and dysarthria is well-known adverse effect during high-dose cytarabine therapy. This case report describes about a patient with acute myeloid leukemia on high-dose cytarabine who developed ataxia and left-sided nystagmus as cerebellar toxicity. These symptoms persisted till 2 days after the termination of high-dose cytarabine the gradually improved with steroids. Patient's good response to methyl prednisolone illustrates immune-mediated mechanism of neurotoxicity.

Acute cerebellar toxicity induced by high dose of cytarabine (HiDAC): A case report

“…Methylprednisolone with a dose of 125 mg daily for three days had been administrated to improve the symptoms. 1 In our case, the patient developed cerebellar dysfunction after receiving the second dose which caused the treatment to be stopped until the symptoms were resolved. Soon after the detection of symptoms, MRI was requested for the patient.…”

“…This form of cytarabine is incorporated into the DNA structure that causes the inhibition of DNA synthesis. 1 Cytarabine is used for the treatment of acute myeloid leukemia (AML) at different doses. A standard dose of cytarabine (100-200 mg/m 2 ) is used as induction therapy, while high doses of cytarabine (HiDAC) are used for post-remission and relapsed/refractory therapy of AML.…”

Retreatment with full-dose cytarabine in a patient with previous neurological toxicity

“…[7][8][9] A decrease in creatinine clearance to less than 60 mL/min, for example, is sufficient to increase risk. 3 Patients with serum creatinine levels in the normal range but with a low baseline level (1.2 mg/dL) may also be at risk. 11 More studies are needed to identify safe doses of cytarabine for patients with kidney failure.…”

“…1 Although cytarabine-induced central nervous system (CNS) toxicity is well known and must be contemplated in high-dose regimens, little has been published on retreatment after a toxic event. [2][3][4][5] To our knowledge, only a few cases have been reported and all the patients needed a dose reduction. 2,6 The lack of information on cytarabine retreatment following CNS toxicity complicates decision-making, as the permanent withdrawal of a potentially curative drug in a patient with a hematological malignancy could have more risks than benefits.…”

Neurotoxic Complications of Chemotherapy in Children. Literature Review

“…Также в литературе опи-саны случаи церебеллита при назначении низких (менее 15 г/м 2 ) доз препарата [39]. Отмечено, что дозозависимость нейротоксического действия цитарабина коррелирует с его нефротоксическим действием: у большинства пациентов с острым повреждением мозжечка отмечалось снижение скорости клубочковой фильтрации [43]. Патогенетический механизм нейротоксичности цитарабина до сих пор не уточнен.…”