Müngen Eren, Yaman Bajin İnci, Öz Sibel, Günbey Ceren, Anlar Banu, Aydin Burca
Department of Pediatric Oncology, Hacettepe University Faculty of Medicine.
Department of Pediatric Neurology, Sihhiye, Ankara, Turkey.
J Pediatr Hematol Oncol. 2022 Oct 1;44(7):402-404. doi: 10.1097/MPH.0000000000002473. Epub 2022 May 2.
Ifosfamide is an important chemotherapeutic agent used in the therapeutic protocols of many malignant tumors. Central nervous system toxicity of ifosfamide manifests with encephalopathy in 10% to 30% of patients treated with ifosfamide. Thiamine and methylene blue have been reported beneficial in the treatment and prevention of ifosfamide-induced encephalopathy (IIE). We describe an episode of encephalopathy developed at the third cycle of ifosfamide treatment in a child with Ewing sarcoma. With the administration of thiamin, the encephalopathy resolved and no episode was noted during subsequent courses of ifosfamide. Previous use of cisplatin, concomitant use of opioids, low levels of serum albumin and hemoglobin, and elevated levels of serum creatinine are potential risk factors for IIE. The current case illustrates the possibility of IIE even in the absence of such additional risk factors, treated successfully with thiamin and draws attention to the need for close neurological monitorization of patients treated with ifosfamide.
异环磷酰胺是一种重要的化疗药物，用于多种恶性肿瘤的治疗方案中。在接受异环磷酰胺治疗的患者中，10%至30%会出现异环磷酰胺所致的中枢神经系统毒性，表现为脑病。据报道，硫胺素和亚甲蓝对异环磷酰胺诱导的脑病（IIE）的治疗和预防有益。我们描述了1例尤因肉瘤患儿在异环磷酰胺治疗第3周期时发生脑病的病例。给予硫胺素后，脑病得到缓解，在随后的异环磷酰胺治疗过程中未再出现该情况。既往使用顺铂、同时使用阿片类药物、血清白蛋白和血红蛋白水平低以及血清肌酐水平升高是IIE的潜在危险因素。本病例表明，即使不存在这些额外的危险因素，也可能发生IIE，用硫胺素治疗成功，并提醒人们注意对接受异环磷酰胺治疗的患者进行密切神经监测的必要性。
