Cancer Chemotherapy and Pharmacology

, Volume 27, Issue 1, pp 76–78 | Cite as

Cerebellar toxicity during cytarabine therapy associated with renal insufficiency

  • Henrik Hasle
Short Communication Cytarabine, Cerebellar Toxicity, Renal Insufficiency


Acute cerebellar toxicity with ataxia and dysarthria is a well-known side effect during high-dose cytarabine therapy. Dose, age, previous neurological disorders, hepatic dysfunction, and renal insufficiency have been inconsistently reported as risk factors. The present paper presents a patient with renal insufficiency who developed severe cerebellar toxicity following treatment with a dose of cytarabine (8 g/m2 over 5 days) not generally expected to be associated with neurotoxicity. Together with a review of the literature, the present case gives evidence of renal insufficiency as a major risk factor in the development of cerebellar toxicity during cytarabine therapy. Reduced doses of cytarabine should be considered in patients with renal impairment.


Cancer Research Neurological Disorder Renal Impairment Renal Insufficiency Cytarabine 
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  1. 1.
    Barnett MJ, Richards MA, Ganesan TS, Waxman JH, Smith BF, Butler MG, Rohatiner AZS, Slevin ML, Lister TA (1985) Central nervous system toxicity of high-dose cytosine arabinoside. Semin Oncol 12 [Suppl 3]:277Google Scholar
  2. 2.
    Benger A, Browman GP, Walker IR (1985) Clinical evidence of a cumulative effect of high-dose cytarabine on the cerebellum in patients with acute leukemia. Cancer Treat Rep 69:240Google Scholar
  3. 3.
    Boesen P, Fallingborg J, Spaun E (1988) Severe persistent cerebellar dysfunction complicating cytosine arabinoside therapy. Acta Med Scand 224:189Google Scholar
  4. 4.
    Camiener GW, Smith CG (1965) Studies of the enzymatic deamination of cytosine arabinoside—part I. Biochem Pharmacol 14:1405Google Scholar
  5. 5.
    Capizzi RL, Yang JL, Cheng E, Bjornsson T, Sahasrabudhe D, Tan R-S, Cheng Y-C (1983) Alteration of the pharmacokinetics of highdose ara-C by its metabolite, high ara-U, in patients with acute leukemia. J Clin Oncol 1:763Google Scholar
  6. 6.
    Cold S (1986) Cerebellar dysfunction during high-dose cytosine arabinoside therapy in a case of acute myelogenous leukaemia. Scand J Haematol 36:165Google Scholar
  7. 7.
    Damon LE, Mass R, Linker CA (1989) The association between high-dose cytarabine neurotoxicity and renal insufficiency. J Clin Oncol 7:1563Google Scholar
  8. 8.
    Dworkin LA, Goldman RD, Zivin LS, Fuchs PC (1985) Cerebellar toxicity following high-dose cytosine arabinoside. J Clin Oncol 3: 613Google Scholar
  9. 9.
    Ellison RR, Holland JF, Weil M, Jacquillat C, Boiron M, Bernard J, Sawitsky A, Rosner F, Gussoff B, Silver RT, Karanas A, Cuttner J, Spurr CL, Hayes DM, Blom J, Leone LA, Haurani F, Kyle R, Hutchinson JL, Forcier FJ, Moon JH (1968) Arabinosyl cytosine: a useful agent in the treatment of acute leukemia in adults. Blood 32: 507Google Scholar
  10. 10.
    Gottlieb D, Bradstock K, Koutts J, Robertson T, Lee C, Castaldi P (1987) The neurotoxicity of high-dose cytosine arabinoside is age related. Cancer 60:1439Google Scholar
  11. 11.
    Grossman L, Baker MA, Sutton DMC, Deck JHN (1983) Central nervous system toxicity of high-dose cytosine arabinoside. Med Pediatr Oncol 11:246Google Scholar
  12. 12.
    Herzig RH, Hines JD, Herzig GP, Wolff SN, Cassileth PA, Lazarus HM, Adelstein DJ, Brown RA, Coccia PF, Strandjord S, Mazza JJ, Fay J, Phillips GL (1987) Cerebellar toxicity with high-dose cytosine arabinoside. J Clin Oncol 5:927Google Scholar
  13. 13.
    Ho DHW (1977) Potential advances in the clinical use of arabinosyl cytosine. Cancer Treat Rep 61:717Google Scholar
  14. 14.
    Lazarus HM, Herzig RH, Herzig GP, Phillips GL, Roessmann U, Fishman DJ (1981) Central nervous system toxicity of high-dose systemic cytosine arabinoside. Cancer 48:2577Google Scholar
  15. 15.
    Lopez JA, Agarwal RP (1984) Acute cerebellar toxicity after high-dose cytarabine associated with CNS accumulation of its metabolite, uracil arabinoside. Cancer Treat Rep 68:1309Google Scholar
  16. 16.
    Nand S, Messmore HL, Patel R, Fisher SG, Fisher RI (1986) Neurotoxicity associated with systemic high-dose cytosine arabinoside. J Clin Oncol 4:571Google Scholar
  17. 17.
    Rudnick SA, Cadman EC, Capizzi RL, Skeel RT, Bertino JR, McIntosh S (1979) High dose cytosine arabinoside (HDARAC) in refractory acute leukemia. Cancer 44:1189Google Scholar
  18. 18.
    Salinsky MC, Levine RL, Aubuchon JP, Schutta HS (1983) Acute cerebellar dysfunction with high-dose ara-C therapy. Cancer 51:426Google Scholar
  19. 19.
    Slevin ML, Piall EM, Aherne GW, Harvey VJ, Johnston A, Lister TA (1983) Effect of dose and schedule on pharmacokinetics of high-dose cytosine arabinoside in plasma and cerebrospinal fluid. J Clin Oncol 1:546Google Scholar
  20. 20.
    Spector R (1982) Pharmacokinetics and metabolism of cytosine arabinoside in the central nervous system. J Pharmacol Exp Ther 222:1Google Scholar
  21. 21.
    Winkelman MD, Hines JD (1983) Cerebellar degeneration caused by high-dose cytosine arabinoside: a clinicopathological study. Ann Neurol 14:520Google Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • Henrik Hasle
    • 1
  1. 1.Division of Haemtology, Department of Oncology and RadiotherapyUniversity Hospital of OdenseOdense CDenmark

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