Cytarabine

Abstract

Cerebral vasospasm: 4 case reports In a prospective, self-controlled study between March 2016 and September 2019, involving 18 patients, 4 childrens [sexes and exact ages not stated] were described, who developed cerebral vasospasm during treatment with cytarabine for acute myeloid leukemia (AML) or pre-B acute lymphocytic leukemia (ALL) [dosages, time to reactions onsets and outcomes not stated]. Case A: The child diagnosed with AML, was admitted to the hospital. Subsequently, the child was initially administered induction chemotherapy with intrathecal cytarabine on day 0 and day 3 along with IV cytarabine twice daily starting before day 1 transcranial Doppler (TCD) ultrasound. Concomitantly, the child also received daunorubicin and etoposide. Prior to chemotherapy initiation, TCD at baseline showed significantly globally elevated cerebral blood flow velocity (CBFV). Post-cytarabine administration, TCD studies revealed substantial increases in CBFVs after administration of intrathecal cytarabine above baseline values. The child was diagnosed with cerebral vasospasm within 4 days of cytarabine therapy. Case B: The child diagnosed with ALL, was admitted to the hospital. Subsequently, the child was administered induction chemotherapy with intrathecal cytarabine on day 0. Concomitantly, the child also received vincristine and dexamethasone. Prior to chemotherapy initiation, transcranial Doppler (TCD) ultrasound at baseline showed significantly globally elevated cerebral blood flow velocity (CBFV). Post-cytarabine administration, TCD studies revealed substantial increases in CBFVs after administration of intrathecal cytarabine above baseline values. Thus, the child was diagnosed with cerebral vasospasm within 4 days of cytarabine therapy. Post meeting the criteria for vasospasm, the child was administered pegaspargase [PEG-asparaginase]. Case C: The child diagnosed with AML, was admitted to the hospital. Subsequently, the child was initially administered induction chemotherapy with intrathecal cytarabine on day 0 along with IV cytarabine twice daily starting before day 1 transcranial Doppler (TCD) ultrasound. Concomitantly, the child also received daunorubicin and etoposide. Prior to chemotherapy initiation, TCD at baseline showed significantly globally elevated cerebral blood flow velocity (CBFV). Post-cytarabine administration, TCD studies revealed substantial increases in CBFVs after administration of intrathecal cytarabine above baseline values. Thus, the child was diagnosed with cerebral vasospasm within 4 days of cytarabine therapy. Case D: The child diagnosed with AML, was admitted to the hospital. Subsequently, the child was initially administered induction chemotherapy with intrathecal cytarabine on day 0 along with IV cytarabine twice daily starting after day 1 transcranial Doppler (TCD) ultrasound. Concomitantly, the child also received daunorubicin. Prior to chemotherapy initiation, TCD at baseline showed significantly globally elevated cerebral blood flow velocity (CBFV). Post-cytarabine administration, TCD studies revealed substantial increases in CBFVs after administration of intrathecal cytarabine above baseline values. Thus, the child was diagnosed with cerebral vasospasm within 4 days of cytarabine therapy. Post meeting the criteria for vasospasm, the child was administered methylprednisolone as a pretreatment for gemtuzumab.