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Chain G, Kalia M, Kestenbaum K, Pappas L, Sechser-Perl A, Campino GA, Zaghloul N. A novel case of prolonged Ifosfamide encephalopathy and long-term treatment with methylene blue: a case report and review of literature. BMC Pediatr 2022; 22:76. [PMID: 35109795 PMCID: PMC8807677 DOI: 10.1186/s12887-022-03144-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/27/2022] [Indexed: 11/22/2022] Open
Abstract
Background Encephalopathy following Ifosfamide treatment is a well-described phenomenon that is typically treated with Methylene Blue (MB). Chloroacetaldehyde, a potentially neurotoxic metabolite of Ifosfamide is hypothesized to cause this encephalopathy. Current guidelines for treatment is to stop Ifosfamide and provide supportive care. MB acts to inhibit Chloroacetaldehyde formation and has been described as a therapy and prophylaxis for Ifosfamide-encephalopathy. MB is effective within 30 min and lasts up to 3 days. Prolonged encephalopathy and MB therapy has not been described in the literature as lasting longer than 30 days following treatment. Case presentation We present the case of an 11-year-old female with autistic spectrum disorder and recurrent episodes of severe somnolence for 7 months following Ifosfamide therapy for her Non-Germinomatous Germ Cell Tumor (GCT). Periods of somnolence occurred prior to receiving cranial RT. Administration of MB gave immediate but limited response, with resolution of somnolence lasting 1-2 days between administrations. The somnolence could not be explained by neuroimaging or laboratory evaluation, but EEG indicated persistent encephalopathy. Conclusion A literature review determines that neurotoxicity is a side effect of Ifosfamide, but this effect has not been described persisting longer than 30 days. Our case continued to require treatment with MB for 7 months following cessation of therapy. We report these novel clinical findings, and hypothesize that there could be a genetic/metabolic component linking this reaction to Ifosfamide with the case patient’s pre-existing autism. This possible association may also correlate to the already-established link between autism and the development of GCTs. This hypothesis leads to further discussion on the suitable usage of Ifosfamide in children with co-morbidities and the necessity of screening prior to its usage.
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Affiliation(s)
- Gabriel Chain
- Department of Pediatrics, The Children's Hospital at Saint Peter's University Hospital, 254 Easton Avenue, New Brunswick, NJ, 08901, USA.
| | - Mudit Kalia
- Department of Pediatrics, The Children's Hospital at Saint Peter's University Hospital, 254 Easton Avenue, New Brunswick, NJ, 08901, USA
| | - Karen Kestenbaum
- Division of Pediatric Hematology/Oncology, The Children's Hospital at Saint Peter's University Hospital, New Brunswick, NJ, 08901, USA
| | - Lara Pappas
- Division of Pediatric Hematology/Oncology, The Children's Hospital at Saint Peter's University Hospital, New Brunswick, NJ, 08901, USA
| | - Anna Sechser-Perl
- Division of Pediatric Hematology/Oncology, The Children's Hospital at Saint Peter's University Hospital, New Brunswick, NJ, 08901, USA
| | - Gadi Abebe Campino
- Pediatric Hemato-Oncology division, Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Nibal Zaghloul
- Department of Pediatrics, The Children's Hospital at Saint Peter's University Hospital, 254 Easton Avenue, New Brunswick, NJ, 08901, USA.,Division of Pediatric Hematology/Oncology, The Children's Hospital at Saint Peter's University Hospital, New Brunswick, NJ, 08901, USA
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Ali Mohamed D, Semedo A, Adeyemi B, Hessissen L, El Kababri M, Allali N, Chat L, El Haddad S. Reversible Encepahlopathy Induced by Ifosfamide with Brain Imaging. Glob Pediatr Health 2021; 8:2333794X211030415. [PMID: 34350307 PMCID: PMC8287358 DOI: 10.1177/2333794x211030415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022] Open
Abstract
Chemotherapy may be responsible for central and/or peripheral neurotoxicity. These
neurological complications are frequent but little known. Some molecules are more
providers, responsible for acute or late complications, sometimes not reversible. Some
manifestations such as acute encephalopathy and acute reversible encephalopathy are
increasingly understood. We report here a case of acute ifosfamide-induced encephalopathy
(EII) with brain damage resolved after discontinuation of this treatment in a 13-years-old
child.
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Affiliation(s)
- Daoud Ali Mohamed
- Pediatric Radiology Department, Children's Hospital of Rabat, University Hospital of Ibn Sina Rabat, Rabat, Morocco
| | - Arthur Semedo
- Pediatric Radiology Department, Children's Hospital of Rabat, University Hospital of Ibn Sina Rabat, Rabat, Morocco
| | - Boris Adeyemi
- Pediatric Radiology Department, Children's Hospital of Rabat, University Hospital of Ibn Sina Rabat, Rabat, Morocco
| | - Leila Hessissen
- Hematology-Oncology Department, Children's Hospital of Rabat, University Hospital of Ibn Sina Rabat, Rabat, Morocco
| | - Maria El Kababri
- Hematology-Oncology Department, Children's Hospital of Rabat, University Hospital of Ibn Sina Rabat, Rabat, Morocco
| | - Nazik Allali
- Pediatric Radiology Department, Children's Hospital of Rabat, University Hospital of Ibn Sina Rabat, Rabat, Morocco
| | - Latifa Chat
- Pediatric Radiology Department, Children's Hospital of Rabat, University Hospital of Ibn Sina Rabat, Rabat, Morocco
| | - Siham El Haddad
- Pediatric Radiology Department, Children's Hospital of Rabat, University Hospital of Ibn Sina Rabat, Rabat, Morocco
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Chambord J, Henny F, Salleron J, Hombourger B, Lider P, Vigneron J, Demore B, Vallance C, Rios M. Ifosfamide‐induced encephalopathy: Brand‐name (HOLOXAN®) vs generic formulation (IFOSFAMIDE EG®). J Clin Pharm Ther 2019; 44:372-380. [DOI: 10.1111/jcpt.12823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/20/2018] [Accepted: 02/05/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jeremy Chambord
- Department of Pharmacy Institut de Cancérologie de Lorraine (ICL) Vandœuvre‐lès‐Nancy France
| | - Fabien Henny
- Department of Pharmacy Institut de Cancérologie de Lorraine (ICL) Vandœuvre‐lès‐Nancy France
| | - Julia Salleron
- Data Biostatistics Unit Institut de Cancérologie de Lorraine (ICL) Vandœuvre‐lès‐Nancy France
| | - Benoit Hombourger
- Department of Pharmacy Institut de Cancérologie de Lorraine (ICL) Vandœuvre‐lès‐Nancy France
| | - Pauline Lider
- Department of Pharmacy Centre hospitalier régional universitaire (CHRU) Vandœuvre‐lès‐Nancy France
| | - Jean Vigneron
- Department of Pharmacy Centre hospitalier régional universitaire (CHRU) Vandœuvre‐lès‐Nancy France
| | - Beatrice Demore
- Department of Pharmacy Centre hospitalier régional universitaire (CHRU) Vandœuvre‐lès‐Nancy France
- EA 4360 Apemac Université de Lorraine Nancy France
| | - Catherine Vallance
- Department of Pharmacy Institut de Cancérologie de Lorraine (ICL) Vandœuvre‐lès‐Nancy France
| | - Maria Rios
- Department of Medical Oncology Institut de Cancérologie de Lorraine (ICL) Vandœuvre‐lès‐Nancy France
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4
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Sun LR, Cooper S. Neurological Complications of the Treatment of Pediatric Neoplastic Disorders. Pediatr Neurol 2018; 85:33-42. [PMID: 30126755 DOI: 10.1016/j.pediatrneurol.2018.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/25/2018] [Indexed: 01/19/2023]
Abstract
Neurological complications resulting from childhood cancer treatments are common. Treatment for childhood neoplastic disorders is often multimodal and may include procedures, cranial irradiation, chemotherapy, transplant, and immunotherapy, each of which carries distinct neurological risks. Procedures, such as lumbar punctures, are commonly used in this population for diagnostic purposes as well as intrathecal medication administration. Surgery is associated with an array of potential neurological complications, with posterior fossa syndrome being a common cause of morbidity in pediatric brain tumor patients after neurosurgical resection. Cranial irradiation can cause late neurological sequelae such as stroke, cerebral vasculopathy, secondary malignancy, and cognitive dysfunction. Neurotoxic effects of chemotherapeutic agents are common and include neuropathy, coagulopathy causing stroke or cerebral sinovenous thrombosis, encephalopathy, seizures, cerebellar dysfunction, myelopathy, and neuropsychologic difficulties. Hematopoietic stem cell transplant has a high risk of neurological complications including central nervous system infection, seizures, and stroke. Immunotherapies, including chimeric antigen receptor-modified T-cells (CAR T-cells) and immune checkpoint inhibitors, are emerging as potentially effective strategies to treat some types of childhood cancer, but may carry with them substantial neurotoxicity which is just beginning to be recognized and studied. With evolving treatment protocols, childhood cancer survivorship is increasing, and the role of the neurologist in managing both the acute and chronic neurological consequences of treatment is becoming more important. Prevention, early recognition, and treatment of therapy-associated neurotoxicity are imperative to ensuring children can remain on the most effective therapeutic regimens and to improve the neurological function and quality of life of childhood cancer survivors.
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Affiliation(s)
- Lisa R Sun
- The Johns Hopkins University School of Medicine, Department of Neurology, Division of Pediatric Neurology, Baltimore, Maryland; The Johns Hopkins University School of Medicine, Department of Neurology, Division of Cerebrovascular Neurology, Baltimore, Maryland.
| | - Stacy Cooper
- The Johns Hopkins University School of Medicine, Department of Oncology, Division of Pediatric Oncology, Baltimore, Maryland
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Incidence et facteurs de risque de l’encéphalopathie à l’ifosfamide chez les patients suivis pour un sarcome. Bull Cancer 2017; 104:208-212. [DOI: 10.1016/j.bulcan.2016.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 08/26/2016] [Accepted: 11/09/2016] [Indexed: 01/19/2023]
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Cordelli DM, Masetti R, Zama D, Toni F, Castelli I, Ricci E, Franzoni E, Pession A. Central Nervous System Complications in Children Receiving Chemotherapy or Hematopoietic Stem Cell Transplantation. Front Pediatr 2017; 5:105. [PMID: 28555178 PMCID: PMC5430164 DOI: 10.3389/fped.2017.00105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/25/2017] [Indexed: 01/19/2023] Open
Abstract
Therapy-related neurotoxicity greatly affects possibility of survival and quality of life of pediatric patients treated for cancer. Central nervous system (CNS) involvement is heterogeneous, varying from very mild and transient symptoms to extremely severe and debilitating, or even lethal syndromes. In this review, we will discuss the broad scenario of CNS complications and toxicities occurring during the treatment of pediatric patients receiving both chemotherapies and hematopoietic stem cell transplantation. Different types of complications are reviewed ranging from therapy related to cerebrovascular with a specific focus on neuroradiologic and clinical features.
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Affiliation(s)
- Duccio Maria Cordelli
- Child Neurology and Psychiatry Unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Riccardo Masetti
- Department of Pediatrics, "Lalla Seràgnoli", Hematology-Oncology Unit, University of Bologna, Bologna, Italy
| | - Daniele Zama
- Department of Pediatrics, "Lalla Seràgnoli", Hematology-Oncology Unit, University of Bologna, Bologna, Italy
| | - Francesco Toni
- Neuroradiology Department, IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Ilaria Castelli
- Department of Pediatrics, "Lalla Seràgnoli", Hematology-Oncology Unit, University of Bologna, Bologna, Italy
| | - Emilia Ricci
- Child Neurology and Psychiatry Unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Emilio Franzoni
- Child Neurology and Psychiatry Unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Andrea Pession
- Department of Pediatrics, "Lalla Seràgnoli", Hematology-Oncology Unit, University of Bologna, Bologna, Italy
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