Evidence for acute neurotoxicity after chemotherapy

Ann Neurol. 2010 Dec;68(6):806-15. doi: 10.1002/ana.22169.

Abstract

Objective: Chronic neurotoxicity is a recognized long-term complication following chemotherapy in a range of diseases. Neurotoxicity adversely affects patients' quality of life. The objective of this study is to examine whether there is evidence of acute neurotoxicity.

Methods: This prospective study included patients with secondary progressive multiple sclerosis (SPMS-BMT, n = 14) and hematological malignancies (HM-BMT, n = 17) receiving chemotherapy as preconditioning for bone marrow transplant. The control groups included SPMS patients matched for demographic and clinical data (SPMS-PL, n = 14) and healthy controls (n = 14). Neurodegeneration was assessed at baseline and longitudinally (months 1, 2, 3, 6, 9, 12, 24, and 36), combining a clinical scale for disability (Expanded Disability Status Scale [EDSS]), a serum protein biomarker for neurodegeneration (neurofilaments, NfH-SMI35), and brain atrophy measures (magnetic resonance imaging).

Results: Disability progression was significantly more acute and severe following chemotherapy compared to placebo. Immediately after starting chemotherapy, serum NfH-SMI35 levels increased in 79% (p < 0.0001) of SPMS-BMT patients and 41% (p < 0.01) of HM-BMT patients compared to 0% of SPMS-PL patients or healthy controls. In SPMS-BMT serum NfH-SMI35 levels were > 100-fold higher 1 month after chemotherapy (29.73ng/ml) compared to baseline (0.28ng/ml, p < 0.0001). High serum NfH-SMI35 levels persisting for at least 3 months were associated with sustained disability progression on the EDSS (p < 0.05). Brain atrophy rates increased acutely in SPMS-BMT (-2.09) compared to SPMS-PL (-1.18, p < 0.05).

Interpretation: Neurotoxicity is an unwanted acute side effect of aggressive chemotherapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Anti-Infective Agents / adverse effects
  • Bone Marrow Transplantation / adverse effects*
  • Brain / pathology*
  • Case-Control Studies
  • Disability Evaluation
  • Drug-Related Side Effects and Adverse Reactions*
  • Female
  • Hematologic Neoplasms / drug therapy
  • Hematologic Neoplasms / surgery
  • Humans
  • Longitudinal Studies
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Multiple Sclerosis, Chronic Progressive / drug therapy
  • Multiple Sclerosis, Chronic Progressive / surgery
  • Neurofilament Proteins / blood
  • Neurotoxicity Syndromes / blood
  • Neurotoxicity Syndromes / diagnosis*
  • Neurotoxicity Syndromes / etiology*
  • Prednisolone / adverse effects
  • Single-Blind Method
  • Statistics, Nonparametric
  • Time Factors
  • Trimethoprim, Sulfamethoxazole Drug Combination / adverse effects

Substances

  • Anti-Infective Agents
  • Neurofilament Proteins
  • neurofilament protein H
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Prednisolone