What is Cytarabine Syndrome?

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Cytarabine is a cytotoxic agent commonly used in cancer chemotherapy.

A common side-effect of high-dose Cytarabine is called Cytarabine Syndrome which is associated with

• Fever
• Malaise (discomfort)
• Myalgia (muscle pain)
• Arthralgia (joint pain)
• Conjunctivitis (inflammation of the cornea)
• Rashes

Since high-dose cytarabine is associated with myelotoxiticity leading to aplasia and hence immune deficiency due to severe *neutropenia,*one needs to rule out infectious causes for the fever since these could quickly develop into a clinical emergency (febrile neutropenia). Typically, preemptive treatment with broad-spectrum antibiotics is strongly indicated.

The cause for the cytarabine syndrome is not completely understood but is hypothesized to be general inflammation due to a cytokine release syndrom-like release of pro-inflammatory cytokines due to Cytarabine mediating the apopotosis of large amounts of primarily neoplastic cells.

How common is cytarabine syndrome?

In our reference study, cytarabine syndrome occured in 43% of all HiDAC (high-dose cytarabine) consolidation cycles and 64% of patients had at least one consolidation cycle with cytarabine syndrome.

How long is the duration of the symptoms?

The duration of the fever is rather short (1-72 hours), with a median duration of only 10.5 hours in our reference study.

References:

Gonen et al 2005: Cytarabine-induced fever complicating the clinical course of leukemia Jirasek et al 2015: Cytarabine syndrome despite corticosteroid premedication in an adult undergoing induction treatment for acute myelogenous leukemia Castleberry et al 1982: The Cytosine Arabinoside (Ara-C) Syndrome Bubalo 2015: Prevention and Treatment of Cytarabine-Induced Keratoconjunctivitis