TY - JOUR
T1 - Post-intrathecal chemotherapy-related paraplegia syndrome in hematological cancer patients
T2 - A systematic review
AU - Monnikhof, Matthijs
AU - Hamming, Gabriella
AU - Crnko, Sandra
AU - Brandsma, Rick
AU - van Rhenen, Anna
AU - Monnikhof, Thomas
AU - Bovenschen, Niels
AU - Kaspers, Gertjan
AU - Flinsenberg, Thijs W H
N1 - Publisher Copyright:
© The Author(s) 2024. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.
PY - 2025/1
Y1 - 2025/1
N2 - BACKGROUND: Intrathecal (IT) chemotherapy is essential in treating hematological malignancies, but it can lead to ascending paraplegia, a condition that currently lacks clear management guidelines.METHODS: We conducted a systematic review, analyzing 1219 studies and 116 patients, adhering to PRISMA guidelines for individual patient data. The study, registered under PROSPERO (CRD42022362121), focused on the onset, diagnostic approaches, and therapeutic interventions associated with this complication, and management strategies to tackle the ascending paraplegia.RESULTS: Paraplegia typically manifests approximately 10 days after chemotherapy, irrespective of injection frequency. In 95% of cases, paralysis stabilizes around the umbilical region, although some patients progress to upper limb involvement and respiratory compromise. Despite various diagnostic methods, consistent inflammatory markers in blood or cerebrospinal fluid are lacking, with approximately 60% of patients showing normal magnetic resonance imaging results at presentation. Misdiagnoses often include transverse myelitis, Guillain-Barré syndrome, and autoimmune radiculitis. Common treatments such as corticosteroids and intravenous immunoglobulins show limited effectiveness.CONCLUSION: Our review delineates the clinical entity of ascending paraplegia following IT chemotherapy, aiming to increase clinician awareness and provide prognostic insight. We introduce the term post-IT paraplegia syndrome to facilitate accurate diagnosis and optimize treatment strategies for affected patients.
AB - BACKGROUND: Intrathecal (IT) chemotherapy is essential in treating hematological malignancies, but it can lead to ascending paraplegia, a condition that currently lacks clear management guidelines.METHODS: We conducted a systematic review, analyzing 1219 studies and 116 patients, adhering to PRISMA guidelines for individual patient data. The study, registered under PROSPERO (CRD42022362121), focused on the onset, diagnostic approaches, and therapeutic interventions associated with this complication, and management strategies to tackle the ascending paraplegia.RESULTS: Paraplegia typically manifests approximately 10 days after chemotherapy, irrespective of injection frequency. In 95% of cases, paralysis stabilizes around the umbilical region, although some patients progress to upper limb involvement and respiratory compromise. Despite various diagnostic methods, consistent inflammatory markers in blood or cerebrospinal fluid are lacking, with approximately 60% of patients showing normal magnetic resonance imaging results at presentation. Misdiagnoses often include transverse myelitis, Guillain-Barré syndrome, and autoimmune radiculitis. Common treatments such as corticosteroids and intravenous immunoglobulins show limited effectiveness.CONCLUSION: Our review delineates the clinical entity of ascending paraplegia following IT chemotherapy, aiming to increase clinician awareness and provide prognostic insight. We introduce the term post-IT paraplegia syndrome to facilitate accurate diagnosis and optimize treatment strategies for affected patients.
KW - cancer
KW - chemotherapy
KW - hematology
KW - intrathecal
KW - paraplegia
UR - http://www.scopus.com/inward/record.url?scp=85214875276&partnerID=8YFLogxK
U2 - 10.1093/noajnl/vdae217
DO - 10.1093/noajnl/vdae217
M3 - Review article
C2 - 39791016
SN - 2632-2498
VL - 7
JO - Neuro-oncology advances
JF - Neuro-oncology advances
IS - 1
M1 - vdae217
ER -