Peripheral neuropathy caused by high-dose cytosine arabinoside treatment in a patient with acute myeloid leukemia.
The central nervous system toxicity of high-dose cytosine arabinoside is well recognized, but the toxicity of cytosine arabinoside in the peripheral nervous system has been infrequently reported. A 49-year-old Japanese man was diagnosed with acute myeloid leukemia. After he achieved complete remission, he received high-dose cytosine arabinoside treatment (2 g/m2 twice a day for 5 days; total, 20 g/m2) as consolidation therapy. The first course of high-dose cytosine arabinoside resulted in no unusual symptoms, but on day 21 of the second course of treatment, the patient complained of numbness in his right foot. Electromyogram and nerve-conduction studies showed peripheral neuropathy in both peroneal nerves. This neuropathy was gradually resolving; however, after the patient received allogeneic bone marrow transplantation, the symptoms worsened, with the development of graft-versus-host disease, and the symptoms subsequently responded to methylprednisolone. Although the mechanisms of peripheral neuropathy are still unclear, high-dose cytosine arabinoside is a therapy that is potentially toxic to the peripheral nervous system, and auto/alloimmunity may play an important role in these mechanisms.
Saito
Takeshi
T
Division of Hematology/Oncology, Department of Internal Medicine, Jikei University School of Medicine, 19-18 Nishishinbashi 3-chome, Minato-ku, Tokyo, 105-8461, Japan. takexsaito@aol.com
Asai
Osamu
O
Dobashi
Nobuaki
N
Yano
Shingo
S
Osawa
Hiroshi
H
Takei
Yutaka
Y
Takahara
Shinobu
S
Ogasawara
Yoji
Y
Yamaguchi
Yuko
Y
Minami
Jiro
J
Usui
Noriko
N
D000208:Acute Disease; D003561:Cytarabine / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007951:Leukemia, Myeloid / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced*
D003561:Cytarabine