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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