Antineoplastics
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Reactions 1338 - 12 Feb 2011 ★ S Antineoplastics Pneumothorax (first report with melphalan): case report A 59-year-old woman with mantel cell lymphoma developed pneumothorax after high-dose chemotherapy, and died. The woman was hospitalised for chemotherapy and autologous peripheral stem cell transplantation. She had previously received CVAD chemotherapy, which had been complicated by pulmonary oedema, pneumonia and renal failure; all complications had resolved. BEAM chemotherapy was initiated with IV carmustine [BCNU] 570mg on day -6, IV cytarabine 190mg twice daily for 8 doses on days -5–-2, IV etoposide 190 twice daily for 8 doses on days -5–-2 and IV melphalan 265 on day -1. She developed pulmonary oedema during chemotherapy, which was successfully treated with diuresis. On day 0, she underwent autologous peripheral stem cell transplantation. Increased breathing difficulties emerged on day 11, and she was intubated. However, ventilation proved difficult, and a large clot was removed from the endotracheal tube. She developed tachycardia, bradycardia and asystole within 30 minutes of intubation. The woman was successfully resuscitated after about 10 minutes in asystole. A chest x-ray then revealed a bilateral pneumothorax. She underwent bilateral chest tube placement, but ventilatory support was then withdrawn according to her advance directives, and she died. An autopsy revealed no haemorrhage, exudate, effusion or rib fractures; no pathological abnormality was evident on microscopic examination of both lobes. Author comment: "Our patient developed SBSP [simultaneous bilateral spontaneous pneumothorax] 11 days following high-dose chemotherapy in preparation for autologous stem cell transplantation. . . Although it is likely that barotrauma from artificial ventilation played a role in SBSP development, the preparative regimen for stem cell transplantation could also have been involved in pathogenesis through a localized disruption in protease/antiprotease balance." Schneider AE, et al. Simultaneous bilateral spontaneous pneumothorax following high-dose chemotherapy and bone marrow transplantation for mantle cell lymphoma without evidence of pulmonary disease. International Journal of Clinical Oncology 15: 635-637, No. 6, 2010. Available from: URL: http:// dx.doi.org/10.1007/s10147-010-0101-6 - USA 803049228 » Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of pneumothorax associated with melphalan. The WHO ADR database contained six reports of pneumothorax associated with melphalan. 1 Reactions 12 Feb 2011 No. 1338 0114-9954/10/1338-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1338 - 12 Feb 2011
★ SAntineoplastics
Pneumothorax (first report with melphalan): casereport
A 59-year-old woman with mantel cell lymphomadeveloped pneumothorax after high-dose chemotherapy,and died.
The woman was hospitalised for chemotherapy andautologous peripheral stem cell transplantation. She hadpreviously received CVAD chemotherapy, which had beencomplicated by pulmonary oedema, pneumonia and renalfailure; all complications had resolved. BEAMchemotherapy was initiated with IV carmustine [BCNU]570mg on day -6, IV cytarabine 190mg twice daily for8 doses on days -5–-2, IV etoposide 190 twice daily for8 doses on days -5–-2 and IV melphalan 265 on day -1. Shedeveloped pulmonary oedema during chemotherapy,which was successfully treated with diuresis. On day 0, sheunderwent autologous peripheral stem cell transplantation.Increased breathing difficulties emerged on day 11, and shewas intubated. However, ventilation proved difficult, and alarge clot was removed from the endotracheal tube. Shedeveloped tachycardia, bradycardia and asystole within30 minutes of intubation.
The woman was successfully resuscitated after about10 minutes in asystole. A chest x-ray then revealed abilateral pneumothorax. She underwent bilateral chest tubeplacement, but ventilatory support was then withdrawnaccording to her advance directives, and she died. Anautopsy revealed no haemorrhage, exudate, effusion or ribfractures; no pathological abnormality was evident onmicroscopic examination of both lobes.
Author comment: "Our patient developed SBSP[simultaneous bilateral spontaneous pneumothorax] 11 daysfollowing high-dose chemotherapy in preparation forautologous stem cell transplantation. . . Although it is likelythat barotrauma from artificial ventilation played a role inSBSP development, the preparative regimen for stem celltransplantation could also have been involved in pathogenesisthrough a localized disruption in protease/antiproteasebalance."Schneider AE, et al. Simultaneous bilateral spontaneous pneumothorax followinghigh-dose chemotherapy and bone marrow transplantation for mantle celllymphoma without evidence of pulmonary disease. International Journal of ClinicalOncology 15: 635-637, No. 6, 2010. Available from: URL: http://dx.doi.org/10.1007/s10147-010-0101-6 - USA 803049228
» Editorial comment: A search of AdisBase, Medline andEmbase did not reveal any previous case reports ofpneumothorax associated with melphalan. The WHO ADRdatabase contained six reports of pneumothorax associatedwith melphalan.
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Reactions 12 Feb 2011 No. 13380114-9954/10/1338-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
