Antineoplastics
1
Reactions 809 - 8 Jul 2000 S Antineoplastics Fatal tumour lysis syndrome: case report A 62-year-old woman developed acute tumour lysis syndrome and died from refractory hyperkalaemia and cardiorespiratory arrest during treatment with antineoplastics for non-Hodgkin’s lymphoma. She had a history of myocardial infarction with congestive heart failure and obstructive pulmonary disease 3 years earlier. She had also been treated with mediastinal radiotherapy for Hodgkin’s disease when she was aged 32 years; the tumour never recurred. After hospitalisation, the woman received prehydration with IV saline and allopurinol. Antineoplastic therapy, consisting of cyclophosphamide 1300mg, doxorubicin 90mg, vincristine 2mg and prednisone 100mg, was started 24 hours later. She developed bradycardia and cardiogenic shock 18 hours after starting antineoplastic therapy. Her BP was 80/50mm Hg and an ECG revealed that her ventricular rhythm was 35 beats/min with wide QRS complexes. Soon after, she developed cardiorespiratory arrest due to asystole. The woman was initially treated with intubation, cardiopulmonary resuscitation, atropine and epinephrine [adrenaline]. She received further treatment with a temporary external pacemaker and a dopamine infusion. Blood tests revealed severe hyperkalaemia, hypocalcaemia, renal failure and metabolic acidosis. She subsequently received IV calcium gluconate, sodium bicarbonate, glucose and insulin, and an internal pacemaker was inserted. She died shortly after from recurrent asystole. Acute tumour lysis syndrome was then definitively diagnosed from laboratory results. Author comment: The effects of acute tumour lysis syndrome may have been worsened by doxorubicin cardiotoxicity. Cardiotoxicity associated with doxorubicin therapy is increased by a history of anthracycline administration, heart failure and previous mediastinal radiotherapy. ‘This may be a possible explanation for the fact that our patient developed cardiac arrhythmias due to ATLS [acute tumour lysis syndrome], without fulfilling all the criteria of a high risk patient.’ Van Der Klooster JM, et al. Asystole during combination chemotherapy for non- Hodgkin’s lymphoma: the acute tumor lysis syndrome. Netherlands Journal of Medicine 56: 147-152, Apr 2000 - Netherlands 807202293 1 Reactions 8 Jul 2000 No. 809 0114-9954/10/0809-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 809 - 8 Jul 2000
SAntineoplastics
Fatal tumour lysis syndrome: case reportA 62-year-old woman developed acute tumour lysis
syndrome and died from refractory hyperkalaemia andcardiorespiratory arrest during treatment with antineoplasticsfor non-Hodgkin’s lymphoma. She had a history of myocardialinfarction with congestive heart failure and obstructivepulmonary disease 3 years earlier. She had also been treatedwith mediastinal radiotherapy for Hodgkin’s disease when shewas aged 32 years; the tumour never recurred.
After hospitalisation, the woman received prehydration withIV saline and allopurinol. Antineoplastic therapy, consisting ofcyclophosphamide 1300mg, doxorubicin 90mg, vincristine2mg and prednisone 100mg, was started 24 hours later. Shedeveloped bradycardia and cardiogenic shock 18 hours afterstarting antineoplastic therapy. Her BP was 80/50mm Hg andan ECG revealed that her ventricular rhythm was 35 beats/minwith wide QRS complexes. Soon after, she developedcardiorespiratory arrest due to asystole.
The woman was initially treated with intubation,cardiopulmonary resuscitation, atropine and epinephrine[adrenaline]. She received further treatment with a temporaryexternal pacemaker and a dopamine infusion. Blood testsrevealed severe hyperkalaemia, hypocalcaemia, renal failureand metabolic acidosis. She subsequently received IV calciumgluconate, sodium bicarbonate, glucose and insulin, and aninternal pacemaker was inserted. She died shortly after fromrecurrent asystole. Acute tumour lysis syndrome was thendefinitively diagnosed from laboratory results.
Author comment: The effects of acute tumour lysissyndrome may have been worsened by doxorubicincardiotoxicity. Cardiotoxicity associated with doxorubicintherapy is increased by a history of anthracyclineadministration, heart failure and previous mediastinalradiotherapy. ‘This may be a possible explanation for the factthat our patient developed cardiac arrhythmias due to ATLS[acute tumour lysis syndrome], without fulfilling all the criteriaof a high risk patient.’Van Der Klooster JM, et al. Asystole during combination chemotherapy for non-Hodgkin’s lymphoma: the acute tumor lysis syndrome. Netherlands Journal ofMedicine 56: 147-152, Apr 2000 - Netherlands 807202293
1
Reactions 8 Jul 2000 No. 8090114-9954/10/0809-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
