Encephalopathy Associated with Ifosfamide Use in the Treatment of Patient with Diffuse Large B Cell Lymphoma

Ifosfamide-Related Encephalopathy (IRE) is a unique neurotoxic side effect of ifosfamide that can occur during or after its administration. The exact underlying mechanism responsible for the development of IRE is not yet known; however, mitochondrial toxicity from one or more ifosfamide metabolites has been proposed. Most cases of IRE are mild and resolve spontaneously with discontinuation of ifosfamide in addition to supportive care, but some patients progress to severe encephalopathy with the risk of seizure, coma, and even death. Electroencephalogram (EEG) abnormalities with or without apparent clinical neurotoxicity symptoms develop in a high percentage of patients treated with ifosfamide, with diffuse slowing being the most common finding; in addition, generalized periodic discharges, triphasic waves, periods of suppression, and patterns consistent with nonconvulsive status epilepticus have also been reported.