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 approximately 1 month after treatment.
PURPOSE: The purpose of this study was to report the clinical and pathologic findings of three cases of rapid vision loss associated with fludarabinetoxicity. 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:Fludarabinetoxicity 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 fludarabinetoxicity in patients who present with vision loss approximately 1 month after treatment.
Authors: Ian W Flinn; Donna S Neuberg; Michael R Grever; Gordon W Dewald; John M Bennett; Elisabeth M Paietta; Mohamad A Hussein; Frederick R Appelbaum; Richard A Larson; Dennis F Moore; Martin S Tallman Journal: J Clin Oncol Date: 2007-02-05 Impact factor: 44.544
Authors: H Nida Sen; Chi-Chao Chan; Rafael C Caruso; Robert N Fariss; Robert B Nussenblatt; Ronald R Buggage Journal: Ophthalmology Date: 2004-03 Impact factor: 12.079
Authors: David A Rizzieri; Jeffrey L Johnson; Donna Niedzwiecki; Edward J Lee; James W Vardiman; Bayard L Powell; Maurice Barcos; Clara D Bloomfield; Charles A Schiffer; Bruce A Peterson; George P Canellos; Richard A Larson Journal: Cancer Date: 2004-04-01 Impact factor: 6.860
Authors: James N Kochenderfer; Robert P T Somerville; Tangying Lu; Victoria Shi; Adrian Bot; John Rossi; Allen Xue; Stephanie L Goff; James C Yang; Richard M Sherry; Christopher A Klebanoff; Udai S Kammula; Marika Sherman; Arianne Perez; Constance M Yuan; Tatyana Feldman; Jonathan W Friedberg; Mark J Roschewski; Steven A Feldman; Lori McIntyre; Mary Ann Toomey; Steven A Rosenberg Journal: J Clin Oncol Date: 2017-03-14 Impact factor: 44.544