Evaluation of methylene blue, thiamine, and/or albumin in the prevention of ifosfamide-related neurotoxicity

Abstract

Summary. A serious adverse effect that can limit the utility of ifosfamide is neurotoxicity, known as ifosfamide-induced encephalopathy (IIE). Information regarding the usefulness of prophylactic administration of methylene blue, thiamine, and albumin to reduce the incidence of IIE is scarce. We present the results of a retrospective chart review evaluating the incidence of IIE in adult patients who received ifosfamide to treat sarcoma at the University of Washington within a 2-year period. Patients who received methylene blue, thiamine, and/or albumin were compared to patients who did not receive these prophylactic agents concurrently with ifosfamide. The primary objective was to evaluate if prophylaxis is associated with a reduced incidence of IIE. Identifying risk factors associated with IIE was a secondary objective. The cost of using prophylaxis with ifosfamide administration was reviewed. Results. A total of 166 cycles were included. For the primary endpoint, more cycles in the prophylaxis group had patients with symptoms of IIE (21.1% in the prophylaxis group vs. 8.4% in the nonprophylaxis group); p = 0.026. The average number of risk factors per cycle was the same in each group; however, the type of risk factors differed. Conclusions. Prophylaxis was not associated with a reduced incidence of IIE, and it does not appear to delay time to onset of symptoms at our institution. Results of this study provide no support for using methylene blue, thiamine, and/or albumin as routine prophylaxis when administering ifosfamide to adults with sarcoma.