Medicine and Pharmacy Faculty, National Institute of Oncology, Medical Oncology Unit, Mohamed V University, Rabat, Morocco.
Medicine and Pharmacy Faculty, Mohamed V University, Rabat, Morocco.
J Oncol Pharm Pract. 2021 Jan;27(1):143-149. doi: 10.1177/1078155220971843. Epub 2020 Nov 5.
Ifosfamide-induced encephalopathy (IIE) is a rare and serious adverse reaction. Thus far, no standard medication has been documentedto be efficient in the reversal of IIE, and while ifosfamide infusion interruption and hydration are recommended, methylene blue (MB) administration remains controversial.
We retrospectively reviewed medical records to assess cases with IIE after ifosfamide infusion. We included all patients having received an ifosfamide infusion during their hospitalization in the medical oncology unit of the National Institute of Oncology in Rabat, Morocco, between September 2016 and September 2017. We subsequently conducted a literature review to determine the role of MB in IIE by searching PubMed using the terms "Methylene Blue" and "Ifosfamide".
A total of 88 patients received ifosfamide, and four patients had IIE. Ifosfamide infusion was stopped immediately after the IIE occurrence, and patients underwent renal function correction with hydration. All patients received MB infusion, and three patients had an improvement of their neurological status. As regards the literature review, 34 articles were reviewed and 16 items were included in the review. Overall, 38 (65.5%) patients received MB infusion and 28 (75.6%) patients responded favorably to the treatment.
Methylene blue can be used as a treatment for IIE owing to the severity of the IIE as well as absence of standard medication. Nonetheless, side effects such as serotonergic syndrome should be investigated. More broadly, prospective studies and controlled trials are needed to explore the contribution of MB in IIE management and encourage its use.
异环磷酰胺诱导性脑病（IIE）是一种罕见且严重的不良反应。迄今为止，尚无有效的标准药物被证明可逆转 IIE，虽然推荐中断异环磷酰胺输注和水化，但亚甲蓝（MB）的应用仍存在争议。
我们回顾性地审查了病历，以评估在输注异环磷酰胺后出现 IIE 的病例。我们纳入了 2016 年 9 月至 2017 年 9 月在摩洛哥拉巴特国家肿瘤研究所肿瘤内科住院期间接受异环磷酰胺输注的所有患者。随后，我们通过在 PubMed 上使用“Methylene Blue”和“ Ifosfamide”这两个术语进行文献检索，以确定 MB 在 IIE 中的作用。
共有 88 例患者接受了异环磷酰胺治疗，其中 4 例发生 IIE。在发生 IIE 后，立即停止异环磷酰胺输注，并通过水化进行肾功能纠正。所有患者均接受了 MB 输注，其中 3 例患者的神经状态得到改善。关于文献综述，共回顾了 34 篇文章，其中 16 篇被纳入综述。总体而言，38 例（65.5%）患者接受了 MB 输注，28 例（75.6%）患者对治疗有良好的反应。
由于 IIE 的严重程度以及缺乏标准药物，亚甲蓝可用于治疗 IIE。然而，应该研究其副作用，如 5-羟色胺能综合征。更广泛地说，需要进行前瞻性研究和对照试验，以探讨 MB 在 IIE 管理中的作用，并鼓励其使用。
