APHON Pediatric Chemotherapy-Biotherapy Renewal

Figure 1. Central and Peripheral Nervous Systems The central nervous system consists of the brain and the spinal cord. The peripheral nervous system is made up of nerves that branch off from the spinal cord and extend to all parts of the body. From Lumen Learning, 2021. https://courses.lumenlearning.com/suny-wmopen-biology2/chapter/components-of- the-nervous-system/. Licensed under CC-BY-NC 4.0, https://creativecommons.org/licenses/by/4.0/legalcode. As with any other system or organ in our bodies, both the central and peripheral nervous systems are affected by chemotherapy and immunotherapy toxicities. Toxicities can be acute and may resolve as soon as the therapy is discontinued or completed, while other toxicities are chronic and may become long term effects of the chemotherapy or immunotherapy that was administered. This section will review some of the more common chemotherapies that have neurotoxic effects associated with them. Novel immunotherapies that have neurotoxic side effects will also be discussed.

Neurotoxicities of Chemotherapy Antimetabolites

Cytarabine. Cytarabine is a cell-cycle-specific antimetabolite used for the treatment of hematologic malignancies; it can be administered intravenously, intrathecally, or subcutaneously. When cytabarine is administered in high doses, patients may develop acute cerebellar syndrome. Symptoms include gait disturbance, seizures, and in some cases, death (Sioka & Kyritsis, 2009). Lower doses of cytarabine have also been associated with posterior reversible encephalopathic syndrome (PRES) (Peddi et al., 2014). Patients with PRES, formerly known as reversible posterior leukoencephalopathy, can present with headache, impaired level of consciousness, confusion, visual disturbances, seizure, nausea, vomiting, encephalopathy, and focal neurologic deficits (Gillard et al., 2019; Peddi et al., 2014). Hypertension has also been frequently observed in patients during the days or hours leading up to the PRES event. PRES can