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. Copyright © 1986 American Cancer Society