Reactions 1041 - 5 Mar 2005

SAntineoplastics

Portal vein thrombosis in children: 5 case reportsFour boys and one girl developed portal vein thrombosis

while receiving antineoplastic therapy.A 7-year-old boy with Burkitt’s lymphoma received

cyclophosphamide, vincristine, prednisolone, methotrexateand hydrocortisone, followed by two courses ofcyclophosphamide, vincristine, prednisolone, doxorubicin,methotrexate and hydrocortisone (COPAdM), then twocourses of cytarabine, methotrexate and hydrocortisone[dosages not stated]. He developed portal vein thrombosisapproximately 18 days after his second cycle of COPAdM andreceived heparin therapy for 10 days. At follow-up, he hadpersistent cavernoma and signs of chronic portalhypertension.

A 15-year-old boy with Ewing’s sarcoma received fivecourses of cyclophosphamide 15 mg/m2/day (days 1–7) anddoxorubicin 35 mg/m2/day (day 8), followed by three coursesof etoposide 100 mg/m2/day (days 1–5) and ifosfamide1.8 g/m2/day (days 1-5), then busulfan 140 mg/m2/day (days6–3) and melphalan 140 mg/m2 (day 3). He developed hepaticveno-occlusive disorder and, 23 days after stem celltransplantation, portal vein thrombosis; he received heparinfor 15 days. Revascularisation occurred after 10 days, with nosigns of portal hypertension.

A 14-year-old boy with bone cancer received six courses ofvincristine 1.5 mg/m2 (day 1), etoposide 150 mg/m2 (days1–3), ifosfamide 3 g/m2 (days 1–3) for two courses thencyclophosphamide, and doxorubicin 20 mg/m2 (days 1–3),followed by two courses of thiotepa 900 mg/m2 (days 6–4)and, 2 months later, busulfan 150 mg/m2 for 4 days andmelphalan 140 mg/m2. He developed hepatic veno-occlusivedisorder and, 64 days after stem cell transplantation, portalvein thrombosis. Revascularisation occurred after 10 days, buthe developed severe GI haemorrhage, and subsequently dieddue to portal hypertension.

A 3.5-year-old boy with brain cancer received cisplatin,vincristine, carboplatin, cyclophosphamide and etoposide[dosages not stated] for 15 months, followed by busulfan150 mg/m2/day for 4 days and thiotepa 300 mg/m2/day for3 days. He developed hepatic veno-occlusive disorder and,51 days after stem cell transplantation, portal vein thrombosis.Revascularisation occurred after 13 days, but he developedsevere GI haemorrhage and subsequently died due to diseaseprogression.

A 2.5-year-old girl with brain cancer received seven cycles ofcisplatin, procarbazine, vincristine, carboplatin andcyclophosphamide [dosages not stated] over 13 months,followed by busulfan 150 mg/m2/day for 4 days and thiotepa300 mg/m2/day for 3 days. She developed hepatic veno-occlusive disorder and, 20 days after stem cell transplantation,portal vein thrombosis. Revascularisation occurred within3 days, but she subsequently died due to disease progression.

Author comment: "The direct hepatic vascular toxicity ofdrugs, especially alkylating agents, appears to play apredominant role and may explain the clinical associationbetween [portal vein thrombosis] and [hepatic veno-occlusivedisease]."Brisse H, et al. Portal vein thrombosis during antineoplastic chemotherapy inchildren: report of five cases and review of the literature. European Journal ofCancer 40: 2659-2666, No. 18, Dec 2004 - France 800979711

1

Reactions 5 Mar 2005 No. 10410114-9954/10/1041-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved