Antineoplastics
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Reactions 1041 - 5 Mar 2005 S Antineoplastics Portal vein thrombosis in children: 5 case reports Four 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, methotrexate and hydrocortisone, followed by two courses of cyclophosphamide, vincristine, prednisolone, doxorubicin, methotrexate and hydrocortisone (COPAdM), then two courses of cytarabine, methotrexate and hydrocortisone [dosages not stated]. He developed portal vein thrombosis approximately 18 days after his second cycle of COPAdM and received heparin therapy for 10 days. At follow-up, he had persistent cavernoma and signs of chronic portal hypertension. A 15-year-old boy with Ewing’s sarcoma received five courses of cyclophosphamide 15 mg/m 2 /day (days 1–7) and doxorubicin 35 mg/m 2 /day (day 8), followed by three courses of etoposide 100 mg/m 2 /day (days 1–5) and ifosfamide 1.8 g/m 2 /day (days 1-5), then busulfan 140 mg/m 2 /day (days 6–3) and melphalan 140 mg/m 2 (day 3). He developed hepatic veno-occlusive disorder and, 23 days after stem cell transplantation, portal vein thrombosis; he received heparin for 15 days. Revascularisation occurred after 10 days, with no signs of portal hypertension. A 14-year-old boy with bone cancer received six courses of vincristine 1.5 mg/m 2 (day 1), etoposide 150 mg/m 2 (days 1–3), ifosfamide 3 g/m 2 (days 1–3) for two courses then cyclophosphamide, and doxorubicin 20 mg/m 2 (days 1–3), followed by two courses of thiotepa 900 mg/m 2 (days 6–4) and, 2 months later, busulfan 150 mg/m 2 for 4 days and melphalan 140 mg/m 2 . He developed hepatic veno-occlusive disorder and, 64 days after stem cell transplantation, portal vein thrombosis. Revascularisation occurred after 10 days, but he developed severe GI haemorrhage, and subsequently died due 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 busulfan 150 mg/m 2 /day for 4 days and thiotepa 300 mg/m 2 /day for 3 days. He developed hepatic veno-occlusive disorder and, 51 days after stem cell transplantation, portal vein thrombosis. Revascularisation occurred after 13 days, but he developed severe GI haemorrhage and subsequently died due to disease progression. A 2.5-year-old girl with brain cancer received seven cycles of cisplatin, procarbazine, vincristine, carboplatin and cyclophosphamide [dosages not stated] over 13 months, followed by busulfan 150 mg/m 2 /day for 4 days and thiotepa 300 mg/m 2 /day for 3 days. She developed hepatic veno- occlusive disorder and, 20 days after stem cell transplantation, portal vein thrombosis. Revascularisation occurred within 3 days, but she subsequently died due to disease progression. Author comment: "The direct hepatic vascular toxicity of drugs, especially alkylating agents, appears to play a predominant role and may explain the clinical association between [portal vein thrombosis] and [hepatic veno-occlusive disease]." Brisse H, et al. Portal vein thrombosis during antineoplastic chemotherapy in children: report of five cases and review of the literature. European Journal of Cancer 40: 2659-2666, No. 18, Dec 2004 - France 800979711 1 Reactions 5 Mar 2005 No. 1041 0114-9954/10/1041-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
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
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Reactions 5 Mar 2005 No. 10410114-9954/10/1041-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
