Cerebellar toxicity following high-dose cytosine arabinoside.

A patient with acute cerebellar toxicity following systemic high-dose cytosine arabinoside (ara-C) 3 g/m2/12 h for secondary acute nonlymphocytic leukemia is reported. Initial symptoms of ataxia and dysarthria emerged at 30 g/m2 cumulative dose and persisted without improvement over a ten-week period. Recurrence and worsening of cerebellar symptoms followed further consolidation treatment with high-dose ara-C. Subsequent autopsy showed extensive Purkinje's cell damage in the lateral cerebellar hemispheres. Persistent severe toxicity can occur at total doses less than those generally recognized.