Complications of Intrathecal Chemotherapy in Adults: Single-Institution Experience in 109 Consecutive Patients

Diana M. Byrnes, Fernando Vargas, Christopher Dermarkarian, Ryan Kahn, Deukwoo Kwon, Judith Hurley, Jonathan H Schatz, Riccardo Masetti

Research output: Contribution to journalArticle

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Abstract

Acute lymphoblastic leukemia and other aggressive lymphoid malignancies like Burkitt leukemia/lymphoma have high incidence of central nervous system (CNS) involvement. Various solid tumors, most notably breast cancer, can also metastasize into the CNS as a late stage complication causing devastating effects. Intrathecal (IT) chemotherapy consisting of methotrexate, cytarabine, or the two in combination is frequently used for the prophylaxis and treatment of CNS metastasis. Because of the high toxicity of these chemotherapeutic agents, however, their side effect profiles are potentially catastrophic. The incidence of neurotoxicity secondary to IT chemotherapy is well defined in the pediatric literature but is poorly reported in adults. Here, we investigated the incidence of neurologic and nonneurologic side effects secondary to IT chemotherapy in 109 consecutive adult patients over a two-year time period at hospitals associated with our institution. Of 355 IT chemotherapy treatments received by these patients, 11 (3.10%) resulted in paresthesias or paralysis, which we defined as significant neurologic events in our analysis. We also examined minor events that arose after IT chemotherapy, including back pain, headache, fever, vomiting, and asthenia. At least one of these occurred after 30.70% of IT chemotherapy doses. Clinicians involved in the care of patients receiving IT chemotherapy should be aware of these findings and consider treatment options lower rate of neurotoxicity such as high-dose systemic methotrexate.

Original languageEnglish (US)
Article number4047617
JournalJournal of Oncology
Volume2019
DOIs
StatePublished - Jan 1 2019

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Drug Therapy
Burkitt Lymphoma
Central Nervous System
Methotrexate
Nervous System
Incidence
Asthenia
Paresthesia
Cytarabine
Back Pain
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Paralysis
Vomiting
Headache
Neoplasms
Patient Care
Fever
Therapeutics
Pediatrics
Breast Neoplasms

ASJC Scopus subject areas

  • Oncology

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Complications of Intrathecal Chemotherapy in Adults : Single-Institution Experience in 109 Consecutive Patients. / Byrnes, Diana M.; Vargas, Fernando; Dermarkarian, Christopher; Kahn, Ryan; Kwon, Deukwoo; Hurley, Judith; Schatz, Jonathan H; Masetti, Riccardo.

In: Journal of Oncology, Vol. 2019, 4047617, 01.01.2019.

Research output: Contribution to journalArticle

Byrnes, Diana M. ; Vargas, Fernando ; Dermarkarian, Christopher ; Kahn, Ryan ; Kwon, Deukwoo ; Hurley, Judith ; Schatz, Jonathan H ; Masetti, Riccardo. / Complications of Intrathecal Chemotherapy in Adults : Single-Institution Experience in 109 Consecutive Patients. In: Journal of Oncology. 2019 ; Vol. 2019.
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