Related Experiment Video
Updated: Dec 18, 2025
Intracranial Cannula Implantation for Serial Locoregional Chimeric Antigen Receptor CAR T Cell Infusions in Mice
Published on: February 24, 2023
Intrathecal chemotherapy-associated cerebral vasospasm in children with hematologic malignancies
Lisa R Sun1,2, Wendy Ziai3, Patrick Brown4
1Division of Pediatric Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA. Lsun20@jhmi.edu.
Insights
A subgroup of children receiving intrathecal cytarabine developed subclinical vasospasm, a potential contributor to neurocognitive deficits. Acute myeloid leukemia and concurrent intravenous cytarabine were identified as risk factors.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Pharmacology
Background:
- Chemotherapy-induced neurotoxicity mechanisms remain poorly understood, hindering preventative strategies.
- Intrathecal cytarabine is a common treatment for hematologic malignancies in children.
- Subclinical vasospasm is hypothesized to contribute to long-term neurocognitive sequelae.
Purpose of the Study:
- To investigate the incidence of subclinical vasospasm in children receiving intrathecal cytarabine.
- To identify potential risk factors associated with vasospasm in this population.
Main Methods:
- Transcranial Doppler ultrasound was used to assess cerebral blood flow velocities.
- Participants were children and young adults (≤25 years) undergoing treatment for hematologic malignancies.
- Serial evaluations were conducted following intrathecal cytarabine administration.
Main Results:
- 22% (4 of 18) of participants exhibited subclinical vasospasm within 4 days of treatment.
- Acute myeloid leukemia diagnosis was associated with increased vasospasm risk.
- Concurrent intravenous cytarabine administration and lack of steroid use were linked to vasospasm.
Conclusions:
- A subset of pediatric patients with hematologic malignancies develops subclinical cerebral vasospasm post-intrathecal cytarabine.
- Further research is required to establish the clinical significance and long-term impact of this vasospasm.
- Identifying vasospasm as a potential factor in neurocognitive dysfunction warrants further investigation into preventative measures.
Background:
Mechanisms of chemotherapy-associated neurotoxicity are poorly understood, and therefore, prevention strategies have not been developed. We hypothesized that a subgroup of children receiving intrathecal cytarabine develops subclinical vasospasm, which may contribute to long-term neurocognitive sequelae of cancer.
Methods:
We used transcranial Doppler ultrasound to serially evaluate cerebral blood flow velocities in participants ≤25 years old receiving intrathecal cytarabine for hematologic malignancies.
Results:
Four of 18 participants (22%) met the criteria for subclinical vasospasm within 4 days of intrathecal cytarabine administration. The distribution of oncologic diagnoses differed between the vasospasm and non-vasospasm groups (p = 0.02). Acute myeloid leukemia was identified as a potential risk factor for vasospasm. Children with vasospasm were more likely to have received intravenous cytarabine (75% versus 0%, p = 0.01) and less likely to have received steroids (25% versus 100%, p = 0.01).
Conclusions:
A subpopulation of children with hematologic malignancies develops subclinical vasospasm after intrathecal cytarabine treatment. Future research is needed to determine the long-term clinical consequences of cerebral vasospasm in this population.
Impact:
A subset of children with hematologic malignancies who receive intrathecal cytarabine experience subclinical cerebral vasospasm, as measured by transcranial Doppler ultrasound. Of children receiving intrathecal cytarabine, those who develop cerebral vasospasm are more likely to have diagnosis of acute myeloid leukemia, more likely to receive concurrent intravenous cytarabine, and less likely to receive steroids as part of their chemotherapy regimen, as compared with children without vasospasm. Future research is needed to determine if vasospasm during chemotherapy is associated with higher rates of neurocognitive dysfunction, and if so, to focus on prevention of these long-term sequelae of childhood cancer.
Related Concept Videos
01:29Drug Delivery: Parenteral Route
There are three primary parenteral routes: intravenous (IV), intramuscular (IM), and subcutaneous (SC). The IV route introduces the drug directly into the bloodstream, ensuring immediate action. The IM route...
01:28Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists
01:27Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists
01:29Chemotherapy-Induced Nausea and Vomiting: Dopamine Receptor Antagonists
Phenothiazines, such as prochlorperazine...