Antineoplastics
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Reactions 1259 - 4 Jul 2009 * Elsewhere in the paper it states that five patients received S Antineoplastics lomustine 600 mg/m 2 . Chamberlain MC, et al. Extended exposure to alkylator chemotherapy: delayed myelodysplastic syndrome and acute myeloid appearance of myelodysplasia. Journal of Neuro-Oncology 93: 229-232, No. 2, leukaemia: 7 case reports 2009 - USA 801146379 In a retrospective study investigating primary glioma, seven patients developed delayed, treatment-related myelodysplastic syndrome (tMDS) or acute myeloid leukaemia (tAML), after receiving treatment with lomustine, procarbazine, temozolomide and/or vincristine. Four men and three women aged 34 to 69 years [see table] underwent resective surgery, and all but one received radiotherapy, for a range of primary gliomas. Five of the patients subsequently received temozolomide in dosages ranging from 6000–28 000 mg/m 2 , on a 5 day schedule every 28 days. One received procarbazine [dosage not stated], and one received lomustine (total dose 600 mg/m 2 ) * , temozolomide and vincristine [dosage not stated](CTV regimen) followed by lomustine and temozolomide (CT regimen). Primary glioma recurred in all but one patient, and salvage therapy was undertaken in five using temozolomide and procarbazine [dosages not stated]. Treatment continued for between 12 and 36 months, and all patients recovered. Between 3 and 31 months after the last chemotherapy exposure, tMDS was diagnosed in all seven patients. There was complete or partial loss of chromosomes 5 and 7, consistent with tMDS. In addition, three patients were diagnosed with tAML: one presenting within a week of confirmation of tMDS, and the other two presented 3 and 8 months after the diagnosis of tMDS. The syndrome manifested as anaemia (six patients), thrombocytopenia (four patients) and neutropenia (three patients). Two of the patients with tMDS underwent bone marrow transplantation; the remaining four received only supportive care. One patient died within a week of diagnosis because of cardiac complications of tAML, confirmed on autopsy. Follow-up ranged from 2 to 12 weeks. Over that time, five patients died: two because of recurrent brain tumour, one as a complication of transplantation (sepsis), and two as a result of tAML. At last follow-up, the remaining two patients were alive: one had undergone transplantation and one had received supportive care only. Author comment: "[T]he present series serves to illustrate a potential morbid adverse effect in treating glioma patients with extended schedules of alkylator-based chemotherapy i.e., tMDS, tAML." Patient and reaction details Patient Drug cycles Time: Diagnosis Outcome sex/age (adjuvant/ last dose/ (y) salvage) reaction onset (m) 1/M/51 PCV a x 6/ 24 MDS e Dead TMZ b x 12 2/F/44 TMZ x 24 28 MDS Dead 3/F/69 TMZ x 6/ 16 MDS/AML f Dead PCV x 6 4/M/38 TMZ x 18/ 22 MDS Dead PCV x 6 5/M/34 TMZ x 24/ 31 MDS Alive PCV x 6 6/F/34 TMZ x 4/ 3 MDA/AML Alive TMZ x 24 7/M/59 CTV c x 5, 31 MDS/AML Dead CT d x 1 a procarbazine, b temozolomide, c lomustine, temozolomide,vincristine, d lomustine, temozolomide, e myelodysplastic syndrome, f acute myeloid leukaemia 1 Reactions 4 Jul 2009 No. 1259 0114-9954/10/1259-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1259 - 4 Jul 2009
* Elsewhere in the paper it states that five patients received SAntineoplastics lomustine 600 mg/m2.
Chamberlain MC, et al. Extended exposure to alkylator chemotherapy: delayedmyelodysplastic syndrome and acute myeloidappearance of myelodysplasia. Journal of Neuro-Oncology 93: 229-232, No. 2,leukaemia: 7 case reports 2009 - USA 801146379
In a retrospective study investigating primary glioma,seven patients developed delayed, treatment-relatedmyelodysplastic syndrome (tMDS) or acute myeloidleukaemia (tAML), after receiving treatment withlomustine, procarbazine, temozolomide and/or vincristine.
Four men and three women aged 34 to 69 years [seetable] underwent resective surgery, and all but onereceived radiotherapy, for a range of primary gliomas. Fiveof the patients subsequently received temozolomide indosages ranging from 6000–28 000 mg/m2, on a 5 dayschedule every 28 days. One received procarbazine[dosage not stated], and one received lomustine (total dose600 mg/m2)*, temozolomide and vincristine [dosage notstated](CTV regimen) followed by lomustine andtemozolomide (CT regimen). Primary glioma recurred in allbut one patient, and salvage therapy was undertaken in fiveusing temozolomide and procarbazine [dosages notstated]. Treatment continued for between 12 and36 months, and all patients recovered. Between 3 and31 months after the last chemotherapy exposure, tMDSwas diagnosed in all seven patients. There was complete orpartial loss of chromosomes 5 and 7, consistent withtMDS. In addition, three patients were diagnosed withtAML: one presenting within a week of confirmation oftMDS, and the other two presented 3 and 8 months afterthe diagnosis of tMDS. The syndrome manifested asanaemia (six patients), thrombocytopenia (four patients)and neutropenia (three patients).
Two of the patients with tMDS underwent bone marrowtransplantation; the remaining four received onlysupportive care. One patient died within a week ofdiagnosis because of cardiac complications of tAML,confirmed on autopsy. Follow-up ranged from 2 to12 weeks. Over that time, five patients died: two becauseof recurrent brain tumour, one as a complication oftransplantation (sepsis), and two as a result of tAML. At lastfollow-up, the remaining two patients were alive: one hadundergone transplantation and one had receivedsupportive care only.
Author comment: "[T]he present series serves to illustratea potential morbid adverse effect in treating glioma patientswith extended schedules of alkylator-based chemotherapyi.e., tMDS, tAML."
Patient and reaction detailsPatient Drug cycles Time: Diagnosis Outcomesex/age (adjuvant/ last dose/(y) salvage) reaction
onset (m)
1/M/51 PCVa x 6/ 24 MDSe Dead TMZb x 12
2/F/44 TMZ x 24 28 MDS Dead3/F/69 TMZ x 6/ 16 MDS/AMLf Dead
PCV x 64/M/38 TMZ x 18/ 22 MDS Dead
PCV x 65/M/34 TMZ x 24/ 31 MDS Alive
PCV x 66/F/34 TMZ x 4/ 3 MDA/AML Alive
TMZ x 247/M/59 CTVc x 5, 31 MDS/AML Dead
CTd x 1a procarbazine, b temozolomide, c lomustine, temozolomide,vincristine,d lomustine, temozolomide, e myelodysplastic syndrome, f acutemyeloid leukaemia
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Reactions 4 Jul 2009 No. 12590114-9954/10/1259-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
