Imtiaz Saba, Muzaffar Narjis
Department of Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore.
J Pak Med Assoc. 2010 Oct;60(10):867-9.
Ifosfamide, a commonly used chemotherapeutic agent in various regimens for many malignancies and has a well known central nervous system side effect. Ifosfamide induced encephalopathy develops in approximately 10-30% of patients exposed to the drug. It is generally reversible after discontinuing the therapy; however cases of fatal neurotoxicity have been reported in literature. Commonly used antidote, Methylene blue; has a moderate efficacy in reversing the encephalopathy followed by lesser response rates by Thiamine. We submit a case report of a young female patient with refractory diffuse large B cell lymphoma who developed severe ifosfamide neurotoxicity. With the use of intravenous thiamine, encephalopathy resolved in our patient within a mean time of 30 hours (average range is 10-30 hours). We found Thiamine to be safe and effective in treatment for ifosfamide induced encephalopathy.
异环磷酰胺是多种恶性肿瘤不同治疗方案中常用的化疗药物，且具有众所周知的中枢神经系统副作用。接触该药物的患者中约有10% - 30%会发生异环磷酰胺诱发的脑病。一般在停止治疗后可逆转；然而，文献中已报道了致命性神经毒性的病例。常用解毒剂亚甲蓝对逆转脑病有一定疗效，其次是硫胺素，但其反应率较低。我们报告一例年轻女性难治性弥漫性大B细胞淋巴瘤患者，该患者发生了严重的异环磷酰胺神经毒性。通过使用静脉注射硫胺素，我们的患者脑病在平均30小时（平均范围为10 - 30小时）内得到缓解。我们发现硫胺素治疗异环磷酰胺诱发的脑病安全有效。
