Antineoplastics
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Reactions 1357 - 25 Jun 2011 S Antineoplastics Tumour lysis syndrome and congestive heart failure: case report A 17-year-old girl with metastatic choriocarcinoma developed tumour lysis syndrome and congestive heart failure during chemotherapy with etoposide, methotrexate, dactinomycin, cyclophosphamide and vincristine (EMA- CO). The girl, whose disease was complicated by thyrotoxicosis and sepsis, started receiving multiagent EMA-CO chemotherapy [dosages, routes and treatment durations not stated]. Two days before treatment cycle 2, she presented with severe dehydration secondary to intractable nausea and vomiting. Laboratory investigations revealed acute renal failure with elevated potassium and phosphorus levels. Findings were consistent with tumour lysis syndrome, and she was admitted to an ICU. Despite receiving 6 days of aggressive hydration therapy and allopurinol, the girl’s uric acid level remained elevated. She then received a dose of rasburicase. Her uric acid level became undetectable in 3 days. Due to multiple complications, including tumour lysis syndrome, deep vein thrombosis, oesophagitis and fungaemia, the girl’s second therapy cycle was delayed by 3 weeks. Her EMA-CO chemotherapy dosages were decreased by 50%, and aggressive hydration and rasburicase were administered as prophylaxis for tumour lysis syndrome. Her third cycle of EMA-CO chemotherapy was administered without delay (at a 25% dose reduction). Pulmonary oedema necessitated intubation on days 2–8 of cycle 3; however, day 8 doses were administered without delay following extubation. At this point echocardiography revealed congestive heart failure and an ejection fraction of 20%; these findings were confirmed on repeat echocardiography 1 week later. Cycle 4 was administered as scheduled. However, pulse dactinomycin was administered on day 8 instead of cyclophosphamide and vincristine. The girl received a total of five cycles of pulse dactinomycin, with two further cycles after testing was negative for serum β-human chorionic gonadotropin. At last observation, her ejection fraction had improved to 45%. Schuman S, et al. Metastatic gestational trophoblastic neoplasia complicated by tumor lysis syndrome, heart failure, and thyrotoxicosis: a case report. Journal of Reproductive Medicine 55: 441-4, No. 910, Sep 2010 - USA 803055845 1 Reactions 25 Jun 2011 No. 1357 0114-9954/10/1357-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1357 - 25 Jun 2011
SAntineoplastics
Tumour lysis syndrome and congestive heartfailure: case report
A 17-year-old girl with metastatic choriocarcinomadeveloped tumour lysis syndrome and congestive heartfailure during chemotherapy with etoposide, methotrexate,dactinomycin, cyclophosphamide and vincristine (EMA-CO).
The girl, whose disease was complicated bythyrotoxicosis and sepsis, started receiving multiagentEMA-CO chemotherapy [dosages, routes and treatmentdurations not stated]. Two days before treatment cycle 2,she presented with severe dehydration secondary tointractable nausea and vomiting. Laboratory investigationsrevealed acute renal failure with elevated potassium andphosphorus levels. Findings were consistent with tumourlysis syndrome, and she was admitted to an ICU.
Despite receiving 6 days of aggressive hydration therapyand allopurinol, the girl’s uric acid level remained elevated.She then received a dose of rasburicase. Her uric acid levelbecame undetectable in 3 days.
Due to multiple complications, including tumour lysissyndrome, deep vein thrombosis, oesophagitis andfungaemia, the girl’s second therapy cycle was delayed by3 weeks. Her EMA-CO chemotherapy dosages weredecreased by 50%, and aggressive hydration andrasburicase were administered as prophylaxis for tumourlysis syndrome. Her third cycle of EMA-CO chemotherapywas administered without delay (at a 25% dose reduction).Pulmonary oedema necessitated intubation on days 2–8 ofcycle 3; however, day 8 doses were administered withoutdelay following extubation. At this point echocardiographyrevealed congestive heart failure and an ejection fraction of20%; these findings were confirmed on repeatechocardiography 1 week later. Cycle 4 was administeredas scheduled. However, pulse dactinomycin wasadministered on day 8 instead of cyclophosphamide andvincristine.
The girl received a total of five cycles of pulsedactinomycin, with two further cycles after testing wasnegative for serum β-human chorionic gonadotropin. Atlast observation, her ejection fraction had improved to45%.Schuman S, et al. Metastatic gestational trophoblastic neoplasia complicated bytumor lysis syndrome, heart failure, and thyrotoxicosis: a case report. Journal ofReproductive Medicine 55: 441-4, No. 910, Sep 2010 - USA 803055845
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Reactions 25 Jun 2011 No. 13570114-9954/10/1357-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
