两名B细胞型急性淋巴细胞白血病青少年鞘内注射阿糖胞苷后的急性神经毒性。

Acute neurotoxicity after intrathecal cytosine arabinoside in two adolescents with acute lymphoblastic leukemia of B-cell type.

作者信息

Resar L M, Phillips P C, Kastan M B, Leventhal B G, Bowman P W, Civin C I

机构信息

Department of Oncology, Johns Hopkins Hospital, Baltimore, Maryland.

出版信息

Cancer. 1993 Jan 1;71(1):117-23. doi: 10.1002/1097-0142(19930101)71:1<117::aid-cncr2820710119>3.0.co;2-k.

DOI:10.1002/1097-0142(19930101)71:1<117::aid-cncr2820710119>3.0.co;2-k

PMID:8416707

Abstract

BACKGROUND

Two adolescents with acute B-cell leukemia (Burkitt leukemia) had acute severe neurotoxicity after treatment with intrathecal (IT) cytosine arabinoside (AraC) at a dose of 50 mg/day for three consecutive days.

RESULTS

A 16-year-old boy had a rapidly ascending myelopathy and encephalopathy 20 hours after receiving the third dose of IT AraC. He remained quadriplegic and required ventilatory assistance for 10 months until his death from progressive tumor. A 12-year-old girl had acute encephalopathy, seizures, and focal neuroimaging abnormalities in the cerebellum and brain stem within 32 hours of the third AraC dose and 8 hours after IT methotrexate (MTX, 12 mg). Her clinical neurologic deficits resolved during the ensuing month. Patient 1 represents the first report to the authors' knowledge of acute severe neurotoxicity after AraC administered as the only IT drug. In Patient 2, IT AraC neurotoxicity may have been potentiated by the single dose of MTX.

CONCLUSION

IT AraC administered for 3 or more consecutive days may lead to profound neurologic dysfunction and require discontinuation of therapy.

摘要

背景

两名患有急性B细胞白血病（伯基特白血病）的青少年在连续三天接受鞘内注射（IT）剂量为50mg/天的阿糖胞苷（AraC）治疗后出现急性严重神经毒性。

结果

一名16岁男孩在接受第三剂IT AraC后20小时出现快速进展的脊髓病和脑病。他一直四肢瘫痪，需要通气支持10个月，直至因肿瘤进展死亡。一名12岁女孩在第三剂AraC后32小时和鞘内注射甲氨蝶呤（MTX，12mg）后8小时出现急性脑病、癫痫发作以及小脑和脑干局灶性神经影像学异常。在随后的一个月内，她的临床神经功能缺损症状得到缓解。据作者所知，患者1是首例仅使用AraC鞘内给药后出现急性严重神经毒性的报告。在患者2中，单剂量MTX可能增强了IT AraC的神经毒性。