Antineoplastics
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Reactions 1285 - 23 Jan 2010 S Antineoplastics Urinary retention due to neurotoxicity in children: 2 case reports Two children experienced urinary retention due to neurotoxicity associated with intrathecal chemotherapy with methotrexate, cytarabine and prednisolone (patient 1) or vincristine [patient 2; dosage not stated]. Patient 1, a 3.5-year-old girl with pre-B cell acute lymphoblastic leukaemia (ALL), started receiving chemotherapy with prednisolone (60 mg/m 2 ), asparaginase, daunorubicin and vincristine (1.5 mg/m 2 ), and triple intrathecal therapy. On day 4 of diagnosis, she received triple intrathecal therapy with prednisolone 24mg, methotrexate 12mg and cytarabine 36mg. Thirteen days later, she developed sudden-onset urinary retention and constipation. Extensive diaper dermatitis was noted. Urinary retention was considered to be due to her voluntarily holding urine as the severe diaper dermatitis was causing pain while urinating. An abdominal ultrasound showed grade 1 bilateral hydronephrosis. She underwent urinary catheterisation and received fluconazole and ceftriaxone. Her diaper dermatitis resolved, but her urinary retention did not recover. Vincristine toxicity was suspected and she received pyridoxine. After 10 days of permanent catheterisation, she had twice daily catheterisations for 8 days to drain her bladder and then she could urinate with the bladder massage. Her third vincristine dose was postponed for 3 weeks. Forty days after initial chemotherapy and intrathecal treatment, an MRI revealed thickened intradural fibres that were adhered to each other at L3–5 in the distal end of the terminal part of the spinal cord. There were also adhesions on the anterior aspect of the thecal sac at the sacral level; findings were considered consistent with arachnoiditis. Thirty days after her urinary retention resolved, she received intrathecal chemotherapy according to the protocol without recurrence of urinary retention. At latest follow-up, she was still receiving intrathecal chemotherapy without any complications. Patient 2, a 10-year-old boy with T cell ALL, started receiving the St Jude remission induction protocol as mentioned above with vincristine, daunorubicin and triple intrathecal therapy. Eleven days after initiation, he developed urinary retention and encopresis. Globe vesicale was observed by abdominal ultrasound. Urinary retention secondary to neuropathy due to vincristine was suspected. He received pyridoxine and, within 2 weeks, his urinary retention had resolved. One week after resolution, vincristine was reinitiated without recurrence of urinary retention. Author comment: "We suppose that spinal cord lesion after chemotherapy and vincristine related autonomic nerve dysfunction is responsible for urinary retention, respectively. In our cases, both drugs were used again without recurrence of urinary retention symptoms." Bay A, et al. Urinary retention in acute lymphoblastic leukemia induction therapy: Two distinct pathologies. Journal of Pediatric Neurology 7: 401-404, No. 4, 2009. Available from: URL: http://dx.doi.org/10.3233/JPN-2009-0321 - Turkey 803004756 1 Reactions 23 Jan 2010 No. 1285 0114-9954/10/1285-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
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Transcript of Antineoplastics
Reactions 1285 - 23 Jan 2010
SAntineoplastics
Urinary retention due to neurotoxicity in children:2 case reports
Two children experienced urinary retention due toneurotoxicity associated with intrathecal chemotherapywith methotrexate, cytarabine and prednisolone (patient 1)or vincristine [patient 2; dosage not stated].
Patient 1, a 3.5-year-old girl with pre-B cell acutelymphoblastic leukaemia (ALL), started receivingchemotherapy with prednisolone (60 mg/m2),asparaginase, daunorubicin and vincristine (1.5 mg/m2),and triple intrathecal therapy. On day 4 of diagnosis, shereceived triple intrathecal therapy with prednisolone 24mg,methotrexate 12mg and cytarabine 36mg. Thirteen dayslater, she developed sudden-onset urinary retention andconstipation. Extensive diaper dermatitis was noted.Urinary retention was considered to be due to hervoluntarily holding urine as the severe diaper dermatitiswas causing pain while urinating. An abdominal ultrasoundshowed grade 1 bilateral hydronephrosis. She underwenturinary catheterisation and received fluconazole andceftriaxone. Her diaper dermatitis resolved, but her urinaryretention did not recover. Vincristine toxicity wassuspected and she received pyridoxine. After 10 days ofpermanent catheterisation, she had twice dailycatheterisations for 8 days to drain her bladder and thenshe could urinate with the bladder massage. Her thirdvincristine dose was postponed for 3 weeks. Forty daysafter initial chemotherapy and intrathecal treatment, anMRI revealed thickened intradural fibres that were adheredto each other at L3–5 in the distal end of the terminal part ofthe spinal cord. There were also adhesions on the anterioraspect of the thecal sac at the sacral level; findings wereconsidered consistent with arachnoiditis. Thirty days afterher urinary retention resolved, she received intrathecalchemotherapy according to the protocol withoutrecurrence of urinary retention. At latest follow-up, she wasstill receiving intrathecal chemotherapy without anycomplications.
Patient 2, a 10-year-old boy with T cell ALL, startedreceiving the St Jude remission induction protocol asmentioned above with vincristine, daunorubicin and tripleintrathecal therapy. Eleven days after initiation, hedeveloped urinary retention and encopresis. Globe vesicalewas observed by abdominal ultrasound. Urinary retentionsecondary to neuropathy due to vincristine was suspected.He received pyridoxine and, within 2 weeks, his urinaryretention had resolved. One week after resolution,vincristine was reinitiated without recurrence of urinaryretention.
Author comment: "We suppose that spinal cord lesionafter chemotherapy and vincristine related autonomic nervedysfunction is responsible for urinary retention, respectively.In our cases, both drugs were used again without recurrenceof urinary retention symptoms."Bay A, et al. Urinary retention in acute lymphoblastic leukemia induction therapy:Two distinct pathologies. Journal of Pediatric Neurology 7: 401-404, No. 4, 2009.Available from: URL: http://dx.doi.org/10.3233/JPN-2009-0321 -Turkey 803004756
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Reactions 23 Jan 2010 No. 12850114-9954/10/1285-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
