Antineoplastics
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Reactions 1179 - 24 Nov 2007 S Antineoplastics Ischaemic hepatitis and heart disorders in an elderly patient with cardiovascular disease: case report An 87-year-old woman with cardiovascular disease developed ischaemic hepatitis and heart disorders during treatment with rituximab, cyclophosphamide, vincristine, doxorubicin and prednisone (R-CHOP) for large B cell lymphoma. The woman, who had a history of atrial fibrillation and hypertension, started receiving IV rituximab 375 mg/m 2 , cyclophosphamide 400 mg/m 2 , doxorubicin 25 mg/m 2 , prednisone 40 mg/m 2 and vincristine 1 mg/m 2 , every 3 weeks. Less than 24 hours after her second cycle, she developed malaise, dyspnoea and loss of consciousness. Laboratory investigations revealed severe fluid, electrolyte and acid-base balance disorders with a potassium level of 2.7 mEq/L, a sodium level of 125 mEq/L and a lactate level of 5.8 mmol/L. She was diagnosed with pulmonary oedema with pleural effusion, cardiac arrhythmias and lower limb oedema. Echocardiography revealed hypertrophic cardiopathy. Over the following days, she developed acute renal and liver failure and worsening pulmonary oedema. Liver function tests revealed AST and ALT levels of up to 100 times the upper limit of normal. She had a creatinine clearance of 16.7 mL/min. The woman received loop diuretics and oxygen therapy and, within 2 weeks, she recovered without sequelae. Author comment: "Pre-existing cardiovascular disease of our patient may have contributed to reduction in hepatic blood flow, responsible for ischaemic hepatitis. Nevertheless, responsibility of R-CHOP cannot be ruled out in front of suggestive chronology with short delay of onset, no concomitant therapy newly introduced, and cardiovascular side effects reported with R-CHOP". Bernard N, et al. Probable ischaemic hepatitis following a R-CHOP chemotherapy: a case report. Drug Safety 30: 945, No. 10, 2007 [abstract] - France 801087434 1 Reactions 24 Nov 2007 No. 1179 0114-9954/10/1179-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 1179 - 24 Nov 2007
SAntineoplastics
Ischaemic hepatitis and heart disorders in anelderly patient with cardiovascular disease: casereport
An 87-year-old woman with cardiovascular diseasedeveloped ischaemic hepatitis and heart disorders duringtreatment with rituximab, cyclophosphamide, vincristine,doxorubicin and prednisone (R-CHOP) for large B celllymphoma.
The woman, who had a history of atrial fibrillation andhypertension, started receiving IV rituximab 375 mg/m2,cyclophosphamide 400 mg/m2, doxorubicin 25 mg/m2,prednisone 40 mg/m2 and vincristine 1 mg/m2, every 3 weeks.Less than 24 hours after her second cycle, she developedmalaise, dyspnoea and loss of consciousness. Laboratoryinvestigations revealed severe fluid, electrolyte and acid-basebalance disorders with a potassium level of 2.7 mEq/L, asodium level of 125 mEq/L and a lactate level of 5.8 mmol/L.She was diagnosed with pulmonary oedema with pleuraleffusion, cardiac arrhythmias and lower limb oedema.Echocardiography revealed hypertrophic cardiopathy. Overthe following days, she developed acute renal and liver failureand worsening pulmonary oedema. Liver function testsrevealed AST and ALT levels of up to 100 times the upper limitof normal. She had a creatinine clearance of 16.7 mL/min.
The woman received loop diuretics and oxygen therapy and,within 2 weeks, she recovered without sequelae.
Author comment: "Pre-existing cardiovascular disease ofour patient may have contributed to reduction in hepaticblood flow, responsible for ischaemic hepatitis. Nevertheless,responsibility of R-CHOP cannot be ruled out in front ofsuggestive chronology with short delay of onset, noconcomitant therapy newly introduced, and cardiovascularside effects reported with R-CHOP".Bernard N, et al. Probable ischaemic hepatitis following a R-CHOP chemotherapy:a case report. Drug Safety 30: 945, No. 10, 2007 [abstract] - France 801087434
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Reactions 24 Nov 2007 No. 11790114-9954/10/1179-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
