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Toxicidad en sistema nervioso central y periférico del tratamiento quimioterapéutico en pacientes mayores de 18 años: revisión sistemática

dc.rights.licenseAtribución-NoComercial-SinDerivadas 4.0 Internacional
dc.contributor.advisorSaavedra Estupiñán, Miriam
dc.contributor.authorCalderón Castro, Andrea del Pilar
dc.date.accessioned2021-02-03T17:12:34Z
dc.date.available2021-02-03T17:12:34Z
dc.date.issued2021-01
dc.identifier.urihttps://repositorio.unal.edu.co/handle/unal/79054
dc.description.abstractIntroduction: The development of cancer therapies offers a longer survival to the patients, but also exposes them to toxic effects that generate morbidity and even mortality. Chemotherapeutic agents have the potential to affect negatively the central and peripheral nervous systems, particularly when administered sequentially or in combination with other antineoplastic therapies. Treatment for acute leukemia includes the use of regimens with two or more antineoplastic drugs, as well as, in the case of acute lymphoblastic leukemia, a greater intrathecal exposure due to the high risk of parenchymal or leptomeningeal infiltration. Materials and methods: With the objective of identifying and describing the studies of toxicity in the central and peripheral nervous system in patients older than 18 years with a diagnosis of acute leukemia who receive chemotherapeutic treatment, a structured literature search was carried out in the MEDLINE and EMBASE databases, with the key words representative of acute leukemia, chemotherapeutic agents, and neurological outcome, the most important being: acute leukemia, vincristine, methotrexate, cytarabine, and neurological manifestations. Including articles from the date of introduction until November 1, 2020. A selection is made in duplicate, initial by reading the title, later reading the title and abstract of the articles, followed by a full-text review of the articles included. Results: 112 articles were included in the review, 98 with full text and 14 abstracts. From there, 199 cases of patients with neurological toxicity associated with the use of chemotherapy were obtained, 138 of those due to compromise in the central nervous system, the most representative were: cerebellar syndrome (32), encephalopathy (21), venous sinus thrombosis (19) , myelopathy (16) and seizures (15). The remaining 61 cases correspond to peripheral nervous system involvement, where motor sensory neuropathy occurred in 26 cases. Discussion: The intrathecal administration of methotrexate and cytarabine is frequent in patients with acute lymphoblastic leukemia due to the great risk of infiltration to the central nervous system; whose neurotoxic effect is due to the depletion of folates, the formation of toxic metabolites and the damage of the blood-brain barrier, allowing the presentation of encephalopathy, encephalomyelitis and even reversible vasoconstriction syndrome. Peripheral neuropathy is associated with the use of vincristine, whose effect on microtubules not only interferes with neoplastic proliferative activity, but also with axonal transport.
dc.description.abstractIntroducción: El desarrollo de terapias contra el el cáncer ofrece a los pacientes una mayor sobrevida, pero también los expone a efectos tóxicos que generan morbilidad e incluso mortalidad. Los agentes quimioterapéuticos tienen el potencial de afectar negativamente tanto el sistema nervioso central como periférico, particularmente cuando son administrados en forma secuencial o combinada con otras terapias antineoplásicas. El tratamiento para la leucemia aguda incluye el uso de esquemas con dos o más antineoplásicos, así como, en el caso de la leucemia linfoblástica aguda, una mayor exposición por vía intratecal debida al alto riesgo de infiltración parenquimatosa o leptomeníngea. Materiales y métodos: Se realiza una revisión estructurada de la literatura con el objetivo Identificar y describir los estudios de toxicidad del tratamiento quimioterapéutico en sistema nervioso central y periférico en los pacientes mayores de 18 años con diagnóstico de leucemia aguda, para lo cual se llevó a cabo una búsqueda de la literatura en las bases de datos MEDLINE y EMBASE, con las palabras clave representativas de leucemia aguda, los quimioterápicos y el desenlace neurológico, siendo los más importantes: acute leukemia, vincristine, methotrexate , cytarabine y neurological manifestations. Incluyendo artículos desde la fecha de introducción hasta el 1 de noviembre de 2020. Resultados: Se incluyeron en la revisión 112 artículos, 98 con texto completo y 14 resúmenes. De allí se obtuvieron 199 casos de pacientes con toxicidad neurológica asociada al uso de quimioterapia, 138 de los por compromiso en sistema nervioso central, los más representativos fueron: síndrome cerebeloso (32), encefalopatía (21), Trombosis de senos venosos (19), mielopatía (16) y Convulsiones (15). Los 61 casos restantes corresponden al compromiso del sistema nervioso periférico, donde la neuropatía sensitivo motora ocurrió en 26 casos. Discusión: Es frecuente la administración intratecal de metotrexato y citarabina en pacientes con leucemia linfoblástica aguda debido al gran riesgo de infiltración al sistema nervioso central;cuyo efecto neurotóxico se debe a la depleción de folatos, la formación de metabolitos tóxicos y el daño de la barrera hematoencefálica, permitiendo la presentación de encefalopatía, encefalomielitis e incluso síndrome de vasoconstricción reversible. La neuropatía periférica se vincula al uso de vincristina, cuyo efecto sobre los microtúbulos no solo interfiere con la actividad proliferativa neoplásica, sino también, con el transporte axonal. Palabras clave: Leucemia aguda, Metotrexato, Vincristina, Citarabina, Manifestaciones neurológicas
dc.format.extent77
dc.format.mimetypeapplication/pdf
dc.language.isospa
dc.rightsDerechos reservados - Universidad Nacional de Colombia
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subject.ddc610 - Medicina y salud::616 - Enfermedades
dc.titleToxicidad en sistema nervioso central y periférico del tratamiento quimioterapéutico en pacientes mayores de 18 años: revisión sistemática
dc.typeOtro
dc.rights.spaAcceso abierto
dc.description.additionalLínea de Investigación: Neurooncología
dc.type.driverinfo:eu-repo/semantics/other
dc.type.versioninfo:eu-repo/semantics/acceptedVersion
dc.publisher.programBogotá - Medicina - Especialidad en Neurología Clínica
dc.contributor.researchgroupNEUROUNAL
dc.description.degreelevelEspecialidades Médicas
dc.publisher.branchUniversidad Nacional de Colombia - Sede Bogotá
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dc.rights.accessrightsinfo:eu-repo/semantics/openAccess
dc.subject.proposalAcute leukemia
dc.subject.proposalLeucemia aguda
dc.subject.proposalMethotrexate
dc.subject.proposalMetotrexato
dc.subject.proposalVincristine
dc.subject.proposalVincristina
dc.subject.proposalCytarabine
dc.subject.proposalCitarabina
dc.subject.proposalNeurological manifestations
dc.subject.proposalManifestaciones neurológicas
dc.type.coarhttp://purl.org/coar/resource_type/c_1843
dc.type.coarversionhttp://purl.org/coar/version/c_ab4af688f83e57aa
dc.type.contentText
oaire.accessrightshttp://purl.org/coar/access_right/c_abf2


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