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Intrathecal mitozantrone has to be prohibited

Leukemia volume 14, pages 2323–2324 (2000)Cite this article

Anissa, a 30-month-old girl, was admitted in our hematology pediatric unit in May 1998 with severe anemia with purpura and general degradation. Neurologic clinical examination was absolutely normal. The blood test revealed: Hb: 38 g/l, WBC: 80 g/l with 25% of blasts, and platelets: 18 g/l. The bone marrow aspiration showed acute myelomonocytic leukemia (AML M4). Anissa was included in French Immunological Hematological Paediatric Society (SHIP) LAME 91 protocol. The first course of chemotherapy included i.v. mitozantrone and cytarabine and intrathecal chemotherapy with methotrexate, cytarabine and corticosteroids.

As the child was in the operating theater for central venous access setting under general anesthesia, we performed the first CNS fluid examination with injection of intrathecal chemotherapy as planned by protocol. This was done by a non-hematologist resident who did not know the color difference between methotrexate and mitozantrone. Cerebral fluid sample examination showed no blast cells. Six hours after the intrathecal injection, she presented with general seizures and was transferred to the intensive care unit, where a lumbar puncture was done. As there was doubt as to cerebral involvement, the planned intravenous chemotherapy was started immediately. Microbiological research and methotrexate dosage in cerebral fluid were negative. Given this surprising result, a mistake in the intrathecal therapy (mitozantrone injection instead of methotrexate) was suspected. Quantitative mitozantrone research in cerebral fluid sample was positive.

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  1. Unité de Greffes de Moelle, Maladies du Sang, Hôpital Claude Huriez, Lille, France

    JH Dalle, A Lambilliotte, AS Defachelles, F Mazingue & B Nelken

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  1. JH Dalle
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  2. A Lambilliotte
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Dalle, J., Lambilliotte, A., Defachelles, A. et al. Intrathecal mitozantrone has to be prohibited. Leukemia 14, 2323–2324 (2000). https://doi.org/10.1038/sj.leu.2401957

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