Antineoplastics
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Reactions 1238 - 7 Feb 2009 ★ S Antineoplastics Acute lymphoblastic leukaemia (first report with bleomycin and cytarabine) and fatal acute myelomonocytic leukaemia (first report with cytarabine): 2 case reports Two HIV-positive patients treated with antineoplastics for Burkitt’s lymphoma later developed acute myelomonocytic leukaemia (patient 1) and acute lymphoblastic leukaemia (patient 2). Patient 1, a 60-year-old man, had been initiated on antiretrovirals 5 years before being diagnosed with Burkitt’s lymphoma. He then received two cycles of cyclophosphamide, methotrexate, bleomycin, vincristine and doxorubicin (Vanderbilt regimen; dosages not stated]. Eight years after the completion of treatment, he presented with acute myelomonocytic leukaemia (French-American-British leukaemia classification M4). He was treated with arsenic trioxide and cytarabine for presumed antecedent myelodysplastic syndrome, but failed to achieve remission and died 5 months later. Patient 2, a 45-year-old man, was diagnosed with Burkitt’s lymphoma and then HIV infection. He was initiated on cyclophosphamide, doxorubicin, vincristine, methotrexate, intrathecal cytarabine and intrathecal methotrexate (CODOX- M regimen; dosages not stated) and ifosfamide, etoposide, cytarabine and intrathecal methotrexate (IVAC regimen; dosages not stated). Antiretrovirals were continued throughout chemotherapy. Two years after achieving complete remission, he presented with thrombocytopenia [time to reaction onset not clearly stated]. Precursor B cell acute lymphoblastic leukaemia, distinct from Burkitt’s lymphoma, was apparent from a bone marrow aspirate. Following treatment with the L20 regimen [drugs not stated], he achieved a complete, lasting remission. Author comment: "It is too early to know if HIV patients are at even greater risk for development of secondary malignancies as a long-term complication of antineoplastic and antiretroviral therapy. It is certainly conceivable, given the cellular and molecular toxicities of antineoplastic and antiretroviral therapy, the combination may result in an increase [sic] risk of myelodysplasia or further lymphodysplasia." Katzel JA, et al. Therapy-related leukemia in patients with human immunodeficiency virus infection after treatment for non-Hodgkin lymphoma. American Journal of Hematology 83: 937-938, No. 12, Dec 2008 - USA 801135480 » Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of acute lymphoblastic leukaemia associated with bleomycin or cytarabine; nor were there any case reports of acute myelomonocytic leukaemia associated with cytarabine. The WHO Adverse Drug Reactions database did not contain any reports of lymphocytic leukaemia [WHO-ART] or acute lymphoblastic leukaemia [MedDRA], associated with bleomycin. There were five reports of lymphocytic leukaemia [WHO-ART], but no reports of acute lymphoblastic leukaemia [MedDRA], associated with cytarabine. The database contained seven reports of monocytic leukaemia [WHO-ART], but no reports of acute myelomonocytic leukaemia [MedDRA], associated with cytarabine. 1 Reactions 7 Feb 2009 No. 1238 0114-9954/10/1238-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 1238 - 7 Feb 2009
★ SAntineoplastics
Acute lymphoblastic leukaemia (first report withbleomycin and cytarabine) and fatal acutemyelomonocytic leukaemia (first report withcytarabine): 2 case reports
Two HIV-positive patients treated with antineoplastics forBurkitt’s lymphoma later developed acute myelomonocyticleukaemia (patient 1) and acute lymphoblastic leukaemia(patient 2).
Patient 1, a 60-year-old man, had been initiated onantiretrovirals 5 years before being diagnosed with Burkitt’slymphoma. He then received two cycles ofcyclophosphamide, methotrexate, bleomycin, vincristine anddoxorubicin (Vanderbilt regimen; dosages not stated]. Eightyears after the completion of treatment, he presented withacute myelomonocytic leukaemia (French-American-Britishleukaemia classification M4). He was treated with arsenictrioxide and cytarabine for presumed antecedentmyelodysplastic syndrome, but failed to achieve remission anddied 5 months later.
Patient 2, a 45-year-old man, was diagnosed with Burkitt’slymphoma and then HIV infection. He was initiated oncyclophosphamide, doxorubicin, vincristine, methotrexate,intrathecal cytarabine and intrathecal methotrexate (CODOX-M regimen; dosages not stated) and ifosfamide, etoposide,cytarabine and intrathecal methotrexate (IVAC regimen;dosages not stated). Antiretrovirals were continued throughoutchemotherapy. Two years after achieving complete remission,he presented with thrombocytopenia [time to reaction onsetnot clearly stated]. Precursor B cell acute lymphoblasticleukaemia, distinct from Burkitt’s lymphoma, was apparentfrom a bone marrow aspirate. Following treatment with theL20 regimen [drugs not stated], he achieved a complete, lastingremission.
Author comment: "It is too early to know if HIV patientsare at even greater risk for development of secondarymalignancies as a long-term complication of antineoplasticand antiretroviral therapy. It is certainly conceivable, given thecellular and molecular toxicities of antineoplastic andantiretroviral therapy, the combination may result in anincrease [sic] risk of myelodysplasia or furtherlymphodysplasia."Katzel JA, et al. Therapy-related leukemia in patients with humanimmunodeficiency virus infection after treatment for non-Hodgkin lymphoma.American Journal of Hematology 83: 937-938, No. 12, Dec 2008 -USA 801135480
» Editorial comment: A search of AdisBase, Medline andEmbase did not reveal any previous case reports of acutelymphoblastic leukaemia associated with bleomycin orcytarabine; nor were there any case reports of acutemyelomonocytic leukaemia associated with cytarabine. TheWHO Adverse Drug Reactions database did not contain anyreports of lymphocytic leukaemia [WHO-ART] or acutelymphoblastic leukaemia [MedDRA], associated with bleomycin.There were five reports of lymphocytic leukaemia [WHO-ART],but no reports of acute lymphoblastic leukaemia [MedDRA],associated with cytarabine. The database contained sevenreports of monocytic leukaemia [WHO-ART], but no reports ofacute myelomonocytic leukaemia [MedDRA], associated withcytarabine.
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Reactions 7 Feb 2009 No. 12380114-9954/10/1238-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
