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Updated: Jul 3, 2026
07:42
Nerve Excitability Assessment in Chemotherapy-induced Neurotoxicity
Published on: April 26, 2012
Progressive paresthesia and weakness after intrathecal chemotherapy
Richard Marshall1, Neel D Gupta, Enrique Palacios
1Tulane University Health Sciences Center, New Orleans, Louisiana, USA.
Summary
A patient with pre-B acute lymphoblastic leukemia (ALL) developed neurological symptoms after receiving a modified chemotherapy regimen. This case highlights potential neurotoxicity risks associated with intrathecal chemotherapy in ALL treatment.
Area of Science:
- Hematology
- Neuro-oncology
- Pharmacology
Background:
- Acute lymphoblastic leukemia (ALL) is a cancer of the blood and bone marrow.
- Pre-B ALL is a specific subtype requiring targeted chemotherapy.
- The hyper-CVAD regimen is a standard treatment for ALL, but modifications may be necessary.
Observation:
- A 53-year-old female diagnosed with pre-B ALL received a modified hyper-CVAD regimen, omitting doxorubicin.
- The patient received two intrathecal injections of cytarabine and methotrexate.
- Two months post-treatment, she presented with significant paresthesias and weakness, leading to wheelchair dependency.
Findings:
- The patient's neurological deficits suggest a potential adverse reaction to the intrathecal chemotherapy agents.
- While doxorubicin was withheld, the combination of intrathecal cytarabine and methotrexate may have contributed to neurotoxicity.
- This presentation indicates a possible complication of ALL treatment, specifically related to intrathecal drug delivery.
Implications:
- This case underscores the importance of monitoring for neurological side effects in patients undergoing ALL treatment with intrathecal chemotherapy.
- Further investigation into the neurotoxic potential of cytarabine and methotrexate, particularly in combination and via intrathecal administration, is warranted.
- Clinical practice may need to consider risk-benefit assessments for intrathecal agents in ALL, especially in modified treatment protocols.
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