title: Ifosfamide-induced neurotoxicity.
abstract: Ifosfamide is an active chemotherapeutic agent in a wide range of gynecologic tumors; favorable response rates have been reported in ovarian (epithelial and germ cell), uterine, and cervical neoplasms. Central neurotoxicity is a known, but poorly described side effect. We report 23 patients who received a total of 75 cycles of ifosfamide, either as a single agent or in combination with other chemotherapeutic agents. Six of twenty-three (26%) experienced grade 4 neurotoxicity; clinical presentation included confusion, aphasia, hallucinations, and coma. All patients exhibited the first evidence of neurotoxicity by the end of the 24-hr infusion. Three of six patients with grade 4 neurotoxicity expired within 14 days of receiving ifosfamide. The neurotoxicity resolved over 2 to 4 days in the remaining patients. Serum albumin was normal (greater than 3.5 g/dl) in 63 cycles of ifosfamide not associated with neurotoxicity. When serum albumin was less than 3.5 g/dl, 6 of 12 cycles were associated with severe neurotoxicity (P less than 0.001). Low serum albumin (less than 3.5 g/dl) appears to be associated with a high risk of severe neurotoxicity in patients receiving single-dose ifosfamide therapy.
authors.affiliation: Department of Obstetrics and Gynecology, Women's Hospital, Los Angeles, California 90033.
authors.forename: J P
authors.initials: JP
authors.lastname: Curtin
authors.forename: P P
authors.initials: PP
authors.lastname: Koonings
authors.forename: M
authors.initials: M
authors.lastname: Gutierrez
authors.forename: J B
authors.initials: JB
authors.lastname: Schlaerth
authors.forename: C P
authors.initials: CP
authors.lastname: Morrow
mesh_terms: D000328:Adult; D000368:Aged; D002490:Central Nervous System / Q000187:drug effects*; D003404:Creatinine / Q000097:blood; D004334:Drug Administration Schedule; D005260:Female; D005833:Genital Neoplasms, Female / Q000097:blood / Q000188:drug therapy; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis
chemical_list: D012709:Serum Albumin; D003404:Creatinine; D007069:Ifosfamide