Painful peripheral neuropathy after treatment with high-dose ifosfamide

Background. Ifosfamide is successfully employed in the treatment of bone an d soft tissue sarcomas in children and young adults. Used at high doses (HD I) the drug may cause severe multiorgan toxicity. Peripheral neuropathy isa less well-known side effect that may limit its use. We describe a 16-year- old girl with a Ewing sarcoma who was given post-operative treatment with H DI (15 mg/m(2) infused over 5 days). After the second course she experience d paresthesias in both feet. After the third course she developed signs of severe toxicity in the CNS, kidneys, heart, and severe pain in her feet. Pr ocedure. Neurologic and neurophysiologic investigations, including neurogra phic studies of motor and sensory nerves, EMG, and thermotest, were perform ed in the acute phase and after 6 and 21 months, respectively. Renal and ca rdiac function was also assessed. Results. She developed generalized weakne ss of the arms and legs and an extremely painful hyperesthesia of the soles . The symptoms improved gradually during follow-up but remained to some ext ent even after more than 2 years. Serial neurophysiologic investigations in dicated classical signs of axonal neuropathy, which tended to improve durin g follow-up. After 18 months the glomerular filtration rate and the effecti ve renal plasma flow were 30 and 12% of normal, respectively, while other o rgan functions had returned to baseline. Conclusions. Symptoms of periphera l neuropathy after HDI may herald severe multiorgan toxicity, if continued. Early administration of anesthetics through the intrathecal route should b e considered in case of ifosfamide-induced painful peripheral neuropathy. M ed Pediatr Oncol 2001;37:379-382. (C) 2001 Wiley-Liss, Inc.