Ifosfamide is an alkylating agent used in the treatment of many
solid tumours, including sarcoma. One of its serious of these is central nervous system (CNS) toxicity known as ifosfamide-induced encephalopathy. The
clinical picture can range from mild somnolence or agitation over
confusion or hallucinations to deep coma. Because this is a rare complication, evidence comes from case reports and series, such as one by J. Pelgrims in the 2000 Br. Journal of Cancer. Some reports describe a rapid recovery of patients with significant neurologic symptoms in as little as 10 minutes, but recovery time can be up to several days. Spontaneous recovery after neurotoxicity often occurs in the same range of one to three days. The researchers attribute the improvement in the patients’ conditions to the treatment with methylene blue therapy. Successful secondary prophylaxis has been described, but ifosfamide neurotoxicity does not always recur.
There is insufficient evidence to recommend methylene blue as a treatment for ifosfamide-induced neurotoxicity in all cases, although case reports suggest some usefulness. Methylene blue may reduce symptoms and hasten recovery, although spontaneous recovery may occur in the same period. Methylene blue therapy is relatively safe for short-term use. What is described and the recovery induced by methylene blue in this case suggests that methylene blue therapy may be considered, along with supportive care measures.
Ajithkumar T, Parkinson C, Shamshad F, et al. Ifosfamide encephalopathy. Clin Oncol. 2007;19:108.
Patel P. Methylene blue for management of ifosfamide-induced encephalopathy. Ann Pharmacother. 2006;40:299.
Pelgrims J, DeVos F, VandenBrande J, et al. Methylene blue in the treatment and prevention of ifosfamide-induced encephalopathy: report of 12 cases and a review of the literature. Br J Cancer. 2000;82:291.