Inadvertent intrathecal administration of vincristine/vindesine in polychemotherapy

The cytostatic drug vincristine arrests mitosis in the metaphase by binding to microtubular proteins. Via binding and the subsequent cleavage of neurotubuli, it arrests axonal transport, explaining neurodegenerative and peripheral neuromuscular side effects following i. v. administration. Inadvertent intrathecal administration of vincristine, which can occur in particular in the context of polychemotherapy with the simultaneous administration of other substances given intrathecally, results in ascending degenerative radiculomyeloencephalopathy, which is almost always progressive and can prove fatal within days to months. In order to avoid this catastrophic outcome, the WHO has made the clear recommendation to prepare and administer vincristine as a short infusion only. The systematic implementation of this recommendation is strongly advised.