title: Severe and irreversible myelopathy after concurrent systemic and intrathecal nucleoside analogue treatment for refractory diffuse large B-cell lymphoma: A case report and review of the literature.
abstract: We report a patient with refractory diffuse large B-cell lymphoma who developed irreversible, severe spinal neurotoxicity after concurrent treatment with intrathecal and systemic cytarabine. Shortly after concomitant administration of intrathecal triple therapy (MTX, dexamethasone and cytarabine) and high-dose systemic cytarabin (R-DHAP protocol) the patient lost control of bowel and bladder function and developed an ascending, irreversible paraplegia. Infectious or neoplastic diseases of the spinal cord were ruled out. A magnetic resonance imaging scan of the spine resulted in a diagnosis of toxic myelitis. Previously observed cases of spinal neurotoxicity after cytarabine treatment are reviewed as well as current guidelines for the use of intrathecal chemotherapy in high-grade non-Hodgkin lymphoma. In summary, severe spinal neurotoxicity of intrathecal chemotherapy is a rare side-effect, however several studies suggest that the neurotoxicity of cytarabine is significantly enhanced by concurrent intrathecal and high-dose systemic administration. Simultaneous high-dose systemic and intrathecal chemotherapy with cytarabine should therefore be avoided.
authors: Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald-Tumor Zentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany w.alsdorf@uke.de.
authors: Winfried H
authors: WH
authors: Alsdorf
authors: Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald-Tumor Zentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Michael
authors: M
authors: Schmitz
authors: Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald-Tumor Zentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Aneta
authors: A
authors: Schieferdecker
authors: Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald-Tumor Zentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Judith
authors: J
authors: Dierlamm
authors: Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald-Tumor Zentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Carsten
authors: C
authors: Bokemeyer
authors: Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald-Tumor Zentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Mascha
authors: M
authors: Binder
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007278:Injections, Spinal; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D012720:Severity of Illness Index; D013118:Spinal Cord Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging; D016896:Treatment Outcome
chemical_list: D003561:Cytarabine; D003907:Dexamethasone; D002945:Cisplatin
keywords: Cytarabine; central nervous system prophylaxis; diffuse large b-cell lymphoma; intrathecal chemotherapy; myelitis