Cytarabine
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Acute cerebellar toxicity: case report A 22-year-old woman developed acute cerebellar toxicity in the form of vertigo and ataxia during treatment with cytarabine for acute myeloid leukaemia (AML). The woman, who was diagnosed with AML M2 with the t (8; 21) translocation, was hospitalised and received induction chemotherapy with cytarabine for 7 days and idarubicine for 3 days. After 28 days from initiation of the induction chemotherapy, a complete response was noted. Since the remission criteria found, high dose of cytarabine was considered as the consolidation or post-remission treatment. Her body surface area (BSA) was reported to be approximately 1.5; and therefore, she was scheduled to receive cytarabine at high dose i.e. 4500mg (3 g/m2) twice a day on days 1, 3 and 5. Cytarabine 4500mg was administered after diluting it in sodium chloride [normal saline] 1000mL solution, and it was infused over 3 hours. Concurrently she also received various other medications. After the second dose of cytarabine, she reported imbalance and vertigo. Examination showed dysmetria on the heel to shin and the finger to nose test. Her gait was ataxic. On day 2, the woman’s cytarabine was withheld. An MRI was found to be normal. Eventually, her symptoms also completely resolved. Therefore, cytarabine was restarted at a reduced dose of 1500mg twice a day (1 g/m2) on days 3, 4 and 5, which was well tolerated, and no symptoms of cerebellar toxicity was observed thereafter. The woman was discharged 3 days after the last dose of the chemotherapy. The AML1-ETO was found to be undetectable, indicating a complete molecular remission. Therefore, further cycles of cytarabine were scheduled to be administered at a reduced dose. Based on the clinical presentation, the acute cerebellar toxicity (vertigo and ataxia) was attributed to high dose of cytarabine. As per the Naranjo adverse drug reaction scale, the causality assessment between the cerebellar toxicity and high dose cytarabine was evaluated as ’probably related’ (score of 8). Rahmani H, et al. Acute cerebellar toxicity induced by high dose of cytarabine (HiDAC): A case report. Journal of Oncology Pharmacy Practice 26: 1492-1494, No. 6, 1 Sep 803514311 2020. Available from: URL: http://doi.org/10.1177/1078155219898747
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Reactions 14 Nov 2020 No. 1830
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