title: Neurological complications after intrathecal liposomal cytarabine application in patients after allogeneic haematopoietic stem cell transplantation.
abstract: Liposomal cytarabine has been proven to be useful for the prevention and intrathecal treatment of neoplastic meningitis. It has no demonstrable myelosuppressive effects and may therefore be an attractive alternative for prophylaxis and treatment of the central nervous system (CNS) relapse after allogeneic haematopoietic stem cell transplantation (HSCT). The use of liposomal cytarabine had not been reported in HSCT recipients. We retrospectively reviewed the feasibility of liposomal cytarabine in the prophylaxis (n=2) and treatment (n=4) of neoplastic meningitis in a cohort of patients after allogeneic HSCT. This report focusses on neurological complications after intrathecal application of liposomal cytarabine. Mild headache was the most commonly reported adverse event. Two patients experienced sacral radiculopathy with irreversible cauda equina syndrome in one patient. Another patient progressed with pre-existing leukencephalopathy. Intrathecal liposomal cytarabine should be used very cautiously in allogeneic HSCT recipients with a history of CNS complications potentially involving cerebral-spinal fluid circulation, since significant neurotoxicity was observed in patients with extensive CNS-directed pre-treatment. The feasibility and safety of liposomal cytarabine in HSCT recipients has to be evaluated in a prospective study.
authors.affiliation: Department of Internal Medicine, Division of Haematology and Oncology, University of Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany. inken.hilgendorf@med.uni-rostock.de
authors.forename: Inken
authors.initials: I
authors.lastname: Hilgendorf
authors.forename: Daniel
authors.initials: D
authors.lastname: Wolff
authors.forename: Christian
authors.initials: C
authors.lastname: Junghanss
authors.forename: Christoph
authors.initials: C
authors.lastname: Kahl
authors.forename: Malte
authors.initials: M
authors.lastname: Leithaeuser
authors.forename: Beate
authors.initials: B
authors.lastname: Steiner
authors.forename: Jochen
authors.initials: J
authors.lastname: Casper
authors.forename: Mathias
authors.initials: M
authors.lastname: Freund
mesh_terms: D000293:Adolescent; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007278:Injections, Spinal; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000628:therapy; D008081:Liposomes; D008223:Lymphoma / Q000150:complications / Q000628:therapy; D008297:Male; D008581:Meningitis / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control*; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000628:therapy; D012189:Retrospective Studies; D014184:Transplantation, Homologous
chemical_list: D000964:Antimetabolites, Antineoplastic; D008081:Liposomes; D003561:Cytarabine