To the Editor.—
We have received reports that vincristine sulfate (Oncovin) has been unintentionally administered intrathecally to patients with CNS leukemia. The accidents occurred at a time when intrathecal methotrexate, cytarabine (Ara-C), or both were being given. The patients have died of ascending paralysis. The resulting respiratory failure has occurred despite the use of thorough flushing of the subarachnoid space, the administration of intrathecal adrenal cortical steroids, and intrathecal as well as intravenous folinic acid, along with other intensive supportive care.We take this means to remind all persons having responsibility for the use of intrathecal drugs in the treatment of leukemic patients that vincristine is now and always has been recommended for intravenous use only and further that its administration intrathecally will be fatal. We have recently added this as an additional reminder in the package insert for this product.