Reactions 1243 - 14 Mar 2009

SAntineoplastics

Hepatic veno-occlusive disease in an infant,successfully treated with methylprednisolone:case report

A 21-month-old boy developed hepatic veno-occlusivedisease during treatment with alternating cycles ofvincristine, dactinomycin and cyclophosphamide (VAC)and vincristine, etoposide and ifosfamide (VEI).Subsequent treatment including high-dosemethylprednisolone was successful.

The boy was diagnosed with rhabdomyosarcoma. Hebegan chemotherapy consisting of vincristine1.5 mg/m2/day on day 1, dactinomycin 0.5 mg/m2/day ondays 1–5, and cyclophosphamide 2.2 g/m2/day on day 1and alternating vincristine 1.5 mg/m2/day on day 1,etoposide 100 mg/m2/day on days 1–5 and ifosfamide1.8 g/m2/day on days 1–5, administered every 3 weeks. Thefirst courses of VAC and VEI were remarkable only for thedevelopment of pancytopenia and neutropenic fever. Onthe third day (day +8 from the start of chemotherapy) aftercompleting the second course of the VAC regimen, hedeveloped fever and abdominal distension. Completeblood count revealed pancytopenia; he also had ahaemoglobin level of 9.6 g/dL and a CRP level of 2.8 mg/dL.A right sided pleural effusion was evident upon chest x-ray.After septic work-up, he received empiric antibiotics. Onday +11, his condition rapidly worsened and he wastransferred to the ICU. His bodyweight had increased by> 10% and he had a WBC count of < 200/mm3, ahaemoglobin level of 6.0 g/dL, a platelet count of1000/mm3, an AST level of 118 U/L, an ALT level of 54 U/L,total and direct bilirubin levels of 1.1 and 0.51 g/dl,respectively, A BUN of < 1 mg/dL, a creatinine level of0.2 mg/dL, a chloride level of 102 mmol/L and an albuminlevel of 3 g/dL. His prothrombin time was 13.7 secondswith an INR of 1.29 and a D-dimer level of 1987 µg/L. Hehad a pH of 7.457, a pCO2 of 44.6mm Hg, a pO2 of59.4mm Hg, a bicarbonate level of 30.8 mmol/L andoxygen saturation of 91.9%, with a 50% O2 hood in use. Arepeat chest x-ray showed lower lung infiltration withpleural effusion bilaterally. Hepatomegaly and massiveascites were observed during abdominal ultrasonography.His condition failed to improve despite blood componentreplacement, fluid restriction and diuretics.

Hepatic veno-occlusive disease was diagnosed and,beginning on the evening of day+12, the boy beganreceiving methylprednisolone 15 mg/kg, every 12 hours forsix doses. By day +15 his ALT, AST, total bilirubin, BUN andCRP levels, as well as his prothrombin time had increasedfurther; however, his condition gradually improvedthereafter. By day +20 AST, ALT and total bilirubin were91 U/L, 197 U/L and 1.4 g/dL, respectively. No sequelae ofvenous-obstructive disease were noted. Followingnormalisation of laboratory results and improvement of hisgeneral condition VAC was replaced with vincristine,epirubicin and cyclophosphamide (VEC). Up to completionof a 1-year course of chemotherapy, liver function tests andabdominal ultrasonography remained normal.Chen I-L, et al. Treatment with High-dose Methylprednisolone for Hepatic Veno-occlusive Disease in a Child with Rhabdomyosarcoma. Pediatrics & Neonatology49: 141-144, No. 4, Aug 2008 - Taiwan 801132207

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Reactions 14 Mar 2009 No. 12430114-9954/10/1243-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved