Background: Ifosfamide, an alkylating agent used for treating various cancers, can cause encephalopathy in 10–30% of adults and 8% of children. Methylene blue has been used to treat ifosfamide-induced encephalopathy (IIE). This study aimed to describe our institutional experience with IIE in children and young adults with cancer, including its clinical manifestations, treatment, and outcomes.Methods: We reviewed the clinical records of patients with cancer aged up to 30 years who developed IIE over 10 years.Results: Twenty-four patients (median age: 17.6 years, range: 4–30 years) were included; 54% were male, and 71% had bone/soft tissue sarcomas. Ifosfamide was administered alone or with other drugs (dose range: 1.5–3.3 g/m2/day). Twelve patients developed IIE after short intermittent infusions (1–3 h), and twelve developed it after continuous infusions (12–24 h). IIE occurred at a median cumulative ifosfamide dose of 18 g/m2. Symptoms appeared within hours to five days and resolved within 24–120 h. An altered mental status was present in all except one patient. Twelve patients had grade 3 IIE (severe somnolence, agitation, and confusion), and five had grade 4 IIE (coma and seizures). Twenty patients (83%) received methylene blue, with symptom resolution in nineteen patients (83%). Imaging studies showed nonspecific findings. Ten patients were re-challenged with ifosfamide; five received prophylactic methylene blue treatment, of whom three had recurrence.Conclusions: IIE can occur with both short intermittent and continuous ifosfamide infusions and presents as an altered mental status, seizures, and, rarely, hemiparesis. Symptoms are transient, and methylene blue may help alleviate this neurotoxicity, but it does not completely prevent its recurrence.
背景：异环磷酰胺是一种用于治疗多种癌症的烷化剂，可在10-30%的成人和8%的儿童中引发脑病。亚甲蓝已被用于治疗异环磷酰胺诱导的脑病。本研究旨在描述我院对儿童和年轻成人癌症患者中异环磷酰胺诱导脑病的临床经验，包括其临床表现、治疗及预后。 方法：我们回顾了10年间年龄不超过30岁、发生异环磷酰胺诱导脑病的癌症患者的临床记录。 结果：共纳入24例患者（中位年龄17.6岁，范围4-30岁）；54%为男性，71%患有骨/软组织肉瘤。异环磷酰胺单独或联合其他药物使用（剂量范围：1.5-3.3 g/m²/天）。12例患者在短期间歇输注（1-3小时）后发生脑病，12例在持续输注（12-24小时）后发生。脑病发生时的中位累积异环磷酰胺剂量为18 g/m²。症状在数小时至五天内出现，并在24-120小时内缓解。除1例外，所有患者均出现意识状态改变。12例患者为3级脑病（严重嗜睡、躁动和意识模糊），5例为4级脑病（昏迷和癫痫发作）。20例患者（83%）接受了亚甲蓝治疗，其中19例（83%）症状缓解。影像学检查显示非特异性表现。10例患者再次使用异环磷酰胺；其中5例接受了预防性亚甲蓝治疗，其中3例脑病复发。 结论：异环磷酰胺诱导脑病可在短期间歇输注和持续输注后发生，表现为意识状态改变、癫痫发作，罕见偏瘫。症状具有一过性，亚甲蓝可能有助于缓解这种神经毒性，但不能完全预防其复发。
肿瘤(癌症)患者之家