Neurological toxicity of ifosfamide.
Ifosfamide is an alkylating agent with well-demonstrated efficacy against a large number of malignant diseases. With cyclophosphamide it shares a toxicity profile characterized by myelosuppression and urotoxicity, but ifosfamide has additionally disclosed adverse neurological effects. Ifosfamide-related central nervous system toxicity is characterized by metabolic encephalopathy of varying severity. Symptoms have been reported in 5-30% of all patients treated with ifosfamide. The mechanism of ifosfamide-related central nervous system toxicity has not been fully elucidated, although the symptoms have most often been noted when the drug is given at high doses or administered orally. The neurotoxicity is generally self-limiting and reversible between 48 and 72 h after discontinuation of ifosfamide, although fatal sequelae have been reported. Therapeutic options are now available.
Nicolao
P
P
Department of Neurology, Second Clinic, University of Padova, Padova, Italy.
Giometto
B
B
D000079:Acetaldehyde / Q000031:analogs & derivatives* / Q000378:metabolism; D000818:Animals; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects*; D001921:Brain / Q000187:drug effects; D002233:Carbocysteine / Q000378:metabolism; D002490:Central Nervous System / Q000187:drug effects*; D005977:Glutarates / Q000652:urine; D005978:Glutathione / Q000378:metabolism; D006801:Humans; D007069:Ifosfamide / Q000009:adverse effects*; D020258:Neurotoxicity Syndromes / Q000209:etiology*
D018906:Antineoplastic Agents, Alkylating; D005977:Glutarates; D002233:Carbocysteine; C004656:chloroacetaldehyde; D005978:Glutathione; D000079:Acetaldehyde; C035736:glutaric acid; D007069:Ifosfamide