Which drug causes cytarabine syndrome?

• A. Cytarabine
• B. Doxorubicin
• C. Vincristine
• D. Cisplatin

Answer: (A)

Cytarabine syndrome is a nonallergic, cytokine-mediated febrile reaction that occurs most often after high-dose cytarabine. Patients develop fever, malaise, myalgias, and sometimes conjunctival injection or a rash within hours of administration. It’s not an infection but an inflammatory response to the drug, which is why acetaminophen premedication and supportive care are used, and why steroids may be considered in more severe cases. This reaction is closely tied to cytarabine, especially in high-dose regimens used for AML and ALL, making cytarabine the drug most likely to cause it. The other agents listed have different dominant toxicities—doxorubicin tends to cause cardiotoxicity and mucositis, vincristine causes neurotoxicity, and cisplatin leads to nephrotoxicity and sensory neuropathy—so they do not produce the cytarabine-specific febrile syndrome.