RAPID VISION LOSS ASSOCIATED WITH FLUDARABINE ADMINISTRATION
- 1 September 2010
- journal article
- case report
- Published by Ovid Technologies (Wolters Kluwer Health) in Retina
- Vol. 30 (8), 1272-1277
- https://doi.org/10.1097/iae.0b013e3181d20589
Abstract
Purpose: The purpose of this study was to report the clinical and pathologic findings of three cases of rapid vision loss associated with fludarabine toxicity. Methods: A retrospective, single-center case series was conducted. Autopsies of the eyes from three cases were performed. Results: A 23-year-old man (Case 1) with systemic lupus erythematosus developed rapid and severe vision loss, generalized neurologic decline, and eventual death after administration of fludarabine before stem cell transplantation. A 48-year-old woman (Case 2) and a 60-year-old man (Case 3), both with metastatic melanoma, had similar courses after receiving fludarabine as part of a preparatory regimen before adoptive cell therapy. Fundus examination showed punctuate yellow flecks in the macula after visual decline in two cases. In all three cases, serum antiretinal antibodies were negative before and after treatment; electrophysiological testing showed markedly decreased B-waves; and pathologic analysis showed loss of retinal bipolar and ganglion cells, gliosis within the retina and optic nerve, and optic nerve atrophy. Conclusion: Fludarabine toxicity can result in severe vision loss attributable to damage to retinal bipolar and ganglion cells. Although effective treatments are not known, care should be taken to consider fludarabine toxicity in patients who present with vision loss ∼1 month after treatment.Keywords
This publication has 9 references indexed in Scilit:
- Ocular toxicity of fludarabine: a purine analogExpert Review of Ophthalmology, 2008
- Phase III Trial of Fludarabine Plus Cyclophosphamide Compared With Fludarabine for Patients With Previously Untreated Chronic Lymphocytic Leukemia: US Intergroup Trial E2997Journal of Clinical Oncology, 2007
- Intensive chemotherapy with and without cranial radiation for Burkitt leukemia and lymphomaCancer, 2004
- Waldenström's macroglobulinemia–associated retinopathyOphthalmology, 2004
- Neurotoxicity of purine analogs: a review.Journal of Clinical Oncology, 1994
- Cyclophosphamide, Methotrexate, and 5-Fluorouracil (CMF)-Induced Ocular ToxicityCancer Investigation, 1990
- Fludarabine phosphate (NSC 312878) infusions for the treatment of acute leukemia: phase I and neuropathological study.1986
- CENTRAL-NERVOUS-SYSTEM TOXICITY OF FLUDARABINE PHOSPHATE1986
- Phase I and II study of fludarabine phosphate in leukemia: therapeutic efficacy with delayed central nervous system toxicity.Journal of Clinical Oncology, 1986