Paraplegia following intra‑thecal therapy in patients with acute lymphoblastic leukaemia: A report of two cases

Zahid,Maheen; Ahmad,Muhammad; Ishaq,Sara; Tahir,Okasha; Waris,Mehak; Umar,Muhammad; Aisha,Marya; Usman,Shermeen; Abid,Maryam

doi:10.3892/wasj.2025.381

Paraplegia following intra‑thecal therapy in patients with acute lymphoblastic leukaemia: A report of two cases

Authors:
- Maheen Zahid
- Muhammad Ahmad
- Sara Ishaq
- Okasha Tahir
- Mehak Waris
- Muhammad Umar
- Marya Aisha
- Shermeen Usman
- Maryam Abid
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Affiliations: Department of Medicine, Mayo Hospital, King Edward Medical University, Lahore, Punjab 53200, Pakistan, Department of Medicine, Bacha Khan Medical College, Mardan, KPK 23200, Pakistan, Department of Medicine, United Medical and Dental College, Karachi, Sindh 74700, Pakistan, Department of Medicine, Khairpur Medial College, Pakistan, Department of Paediatrics, Federal General Hospital, Islamabad 44000, Pakistan
Published online on: July 30, 2025 https://doi.org/10.3892/wasj.2025.381
Article Number: 93
Copyright : © Zahid et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].

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Abstract

Acute lymphoblastic leukaemia (ALL) is the most common paediatric cancer and is often treated with intrathecal therapy (IT therapy) to prevent central nervous system (CNS) relapses. Although effective, IT therapy can lead to rare, yet severe neurological complications. The present study describes the cases of 2 adolescent males (both 17 years of age) diagnosed with Philadelphia chromosome‑positive B‑cell ALL and T‑cell ALL, respectively, who developed acute paraplegia following IT therapy. Both patients had achieved haematological remission and were undergoing CNS prophylaxis as part of their treatment regimen, one following the St. Jude protocol and the other receiving hyperfractionated cyclophosphamide, vincristine, doxorubicin, and prednisolone (hyper‑CVAD). Neurological symptoms manifested within days of IT therapy, initially presenting as urinary retention, followed by progressive lower limb weakness and stool incontinence. A diagnostic workup, including cerebrospinal fluid analysis and MRI imaging, ruled out infectious or malignant CNS involvement; however, the results of this workup suggested neurotoxicity‑induced lumbosacral radiculopathy. Electrodiagnostic analyses confirmed acute axonal motor‑sensory neuropathy with absent motor responses in the lower limbs. Management included plasmapheresis and supportive care, with variable neurological recovery. On the whole, the present study highlights the rare, yet severe risk of developing paraplegia and other neurotoxic effects following IT therapy in paediatric patients. The early identification and prompt management of neurotoxicity are crucial to minimize long‑term complications and improve functional outcomes.

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