title: Progressive ascending paralysis following administration of intrathecal and intravenous cytosine arabinoside. A Pediatric Oncology Group study.
abstract: Two childhood acute myelogenous leukemia (AML) patients receiving intrathecal (IT) and intravenous (IV) cytosine arabinoside (Ara-C) developed progressive ascending paralysis, resulting in death in one patient. Necropsy findings on this patient included spinal cord demyelination characteristic of Ara-C neurotoxicity. An unusual aspect of these two cases was the delay between cessation of IT therapy and the onset of neurologic symptoms. These patients received relatively low total doses of IT Ara-C and standard doses of IV Ara-C. Previous studies have shown that Ara-C equilibrates readily between serum and cerebrospinal fluid; this implies that total IV and IT doses of Ara-C may be additive in relation to development of neurotoxicity. For these reasons, use of IV and IT Ara-C in childhood AML must be approached with greater caution, especially if neurologic abnormalities develop during or after therapy.
authors.forename: S F
authors.initials: SF
authors.lastname: Dunton
authors.forename: R
authors.initials: R
authors.lastname: Nitschke
authors.forename: W E
authors.initials: WE
authors.lastname: Spruce
authors.forename: J
authors.initials: J
authors.lastname: Bodensteiner
authors.forename: H F
authors.initials: HF
authors.lastname: Krous
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007278:Injections, Spinal; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000532:radiotherapy; D008168:Lung / Q000098:blood supply / Q000473:pathology; D009132:Muscles / Q000473:pathology; D010243:Paralysis / Q000139:chemically induced* / Q000473:pathology; D013116:Spinal Cord / Q000473:pathology / Q000648:ultrastructure; D013997:Time Factors
chemical_list: D003561:Cytarabine