Acute lymphoblastic leukemia and other aggressive lymphoid malignancies like Burkitt leukemia/lymphoma have high incidence\nof central nervous system(CNS) involvement. Various solid tumors, most notably breast cancer, can also metastasize into the CNS\nas a late stage complication causing devastating effects. Intrathecal (IT) chemotherapy consisting of methotrexate, cytarabine, or\nthe two in combination is frequently used for the prophylaxis and treatment of CNSmetastasis. Because of the high toxicity of these\nchemotherapeutic agents, however, their side effect profiles are potentially catastrophic.The incidence of neurotoxicity secondary\nto IT chemotherapy is well defined in the pediatric literature but is poorly reported in adults. Here, we investigated the incidence\nof neurologic and nonneurologic side effects secondary to IT chemotherapy in 109 consecutive adult patients over a two-year time\nperiod at hospitals associated with our institution. Of 355 IT chemotherapy treatments received by these patients, 11 (3.10%) resulted\nin paresthesias or paralysis, which we defined as significant neurologic events in our analysis.We also examined minor events that\narose after IT chemotherapy, including back pain, headache, fever, vomiting, and asthenia. At least one of these occurred after\n30.70% of IT chemotherapy doses. Clinicians involved in the care of patients receiving IT chemotherapy should be aware of these\nfindings and consider treatment options lower rate of neurotoxicity such as high-dose systemic methotrexate.
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