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Methylene blue and ifosfamide-induced encephalopathy: Myth or reality?
Halima Abahssain1, Badreddine Moukafih1, Hajar Essangri2
1Medicine and Pharmacy Faculty, National Institute of Oncology, Medical Oncology Unit, Mohamed V University, Rabat, Morocco.
Background:
Ifosfamide-induced encephalopathy (IIE) is a rare and serious adverse reaction. Thus far, no standard medication has been documentedto be efficient in the reversal of IIE, and while ifosfamide infusion interruption and hydration are recommended, methylene blue (MB) administration remains controversial.
Methods:
We retrospectively reviewed medical records to assess cases with IIE after ifosfamide infusion. We included all patients having received an ifosfamide infusion during their hospitalization in the medical oncology unit of the National Institute of Oncology in Rabat, Morocco, between September 2016 and September 2017. We subsequently conducted a literature review to determine the role of MB in IIE by searching PubMed using the terms "Methylene Blue" and "Ifosfamide".
Results:
A total of 88 patients received ifosfamide, and four patients had IIE. Ifosfamide infusion was stopped immediately after the IIE occurrence, and patients underwent renal function correction with hydration. All patients received MB infusion, and three patients had an improvement of their neurological status. As regards the literature review, 34 articles were reviewed and 16 items were included in the review. Overall, 38 (65.5%) patients received MB infusion and 28 (75.6%) patients responded favorably to the treatment.
Conclusions:
Methylene blue can be used as a treatment for IIE owing to the severity of the IIE as well as absence of standard medication. Nonetheless, side effects such as serotonergic syndrome should be investigated. More broadly, prospective studies and controlled trials are needed to explore the contribution of MB in IIE management and encourage its use.
Insights
Methylene blue (MB) may effectively treat ifosfamide-induced encephalopathy (IIE), a rare but serious condition. This study suggests MB offers a potential treatment option when standard therapies are lacking.
Area of Science:
- Oncology
- Neuroscience
- Pharmacology
Background:
- Ifosfamide-induced encephalopathy (IIE) is a rare, severe adverse reaction to ifosfamide chemotherapy.
- Currently, no standard medication effectively reverses IIE; treatment typically involves interrupting ifosfamide infusion and hydration.
- The use of methylene blue (MB) for IIE remains controversial.
Purpose of the Study:
- To evaluate the efficacy of methylene blue (MB) in treating ifosfamide-induced encephalopathy (IIE).
- To assess the role of MB in managing IIE by reviewing clinical cases and existing literature.
Main Methods:
- Retrospective review of medical records for patients with IIE post-ifosfamide infusion (September 2016 - September 2017).
- Literature search on PubMed using terms 'Methylene Blue' and 'Ifosfamide' to identify relevant studies.
- Analysis of case series and literature data on MB administration for IIE.
Main Results:
- Four out of 88 ifosfamide-treated patients developed IIE.
- All four patients received MB infusion after ifosfamide cessation and hydration; three showed neurological improvement.
- Literature review of 16 articles indicated that 65.5% of patients received MB, with 75.6% responding favorably.
Conclusions:
- Methylene blue presents a viable treatment option for ifosfamide-induced encephalopathy due to its severity and lack of standard therapies.
- Further investigation into potential side effects, such as serotonergic syndrome, is warranted.
- Prospective studies and controlled trials are necessary to confirm MB's contribution to IIE management.
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