Antineoplastics
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Reactions 1290 - 27 Feb 2010 transfusions in addition to eptacog alfa twice daily for 11 days. His coagulation parameters remained mostly S Antineoplastics normal during eptacog alfa therapy. His recovery was slow over the next 3 weeks, but there were no signs of further Haemorrhage in paediatric patients, treated with bleeding, so his chemotherapy was continued. During the eptacog alfa: 3 case reports next cycle, haemorrhage recurred but was partially Three paediatric patients developed haemorrhage during controlled with eptacog alfa. He eventually died from chemotherapy for various malignancies. multiple organ failure. The first patient was a full-term male neonate who had severe hepatomegaly on the first day of life. After his liver Bili´ c E, et al. Recombinant activated factor VII controls chemotherapy-related hemorrhage in patients with solid intra-abdominal tumors: A report of three biopsy showed hepatoblastoma, he received cisplatin, pediatric cases. Acta Clinica Croatica 48: 161-166, No. 2, Jun 2009 - doxorubicin [dosages not stated], albumin and blood Croatia 803006079 products. Despite supportive therapy, his clinical and haematological status worsened [time to reaction onset not stated]; his haemoglobin dropped to 74 g/L and his platelet count dropped to 30 × 10 9 /L. His prothrombin time decreased to 0.30, and his activated partial thromboplastin time increased to 74.3 seconds. His abdominal girth increased from 44 to 48cm; a CT scan showed intraperitoneal haemorrhage. He started to show signs of oedema and tachycardia, with imminent cardiorespiratory insufficiency. Supportive therapy temporarily improved his condition but his bleeding continued. Treatment with eptacog alfa [recombinant factor VIIa] resulted in complete cessation of bleeding and significant clinical improvement. His bleeding parameters improved and his abdominal girth decreased to 47cm. Blood transfusions were discontinued. After the last cycle of chemotherapy, a CT scan showed regression of the tumour. He was then referred for surgery and made a full recovery after 3 years. The second patient was an 8-year-old boy who had a 3-week history of abdominal pain and vomiting; he was diagnosed with embryonic rhabdomyosarcoma. After his first cycle of ifosfamide/vincristine/dactinomycin therapy [dosages and time to reaction onset not clearly stated], he developed severe bone marrow aplasia, bilateral pneumonia, pulmonary oedema, sepsis, multi-organ dysfunction syndrome and severe intraabdominal bleeding. He received blood transfusions but the bleeding persisted. On the third day after the first chemotherapy cycle, he had persistent GI bleeding, melena, and haematemesis. An ultrasound showed fluid accumulation within the abdominal cavity. He received eptacog alfa at 3-hour intervals which temporarily stopped the bleeding. He was transferred to the ICU where he received four more doses eptacog alfa over the next 2 days. His bleeding stopped after the second day of eptacog alfa. He was then treated for iatrogenic bone marrow aplasia, sepsis and bilateral pneumonia. Three weeks after ICU admission, his condition stabilised and chemotherapy was continued with the same agents. After debulking surgery and three more cycles of chemotherapy, the tumour became undetectable. Radiotherapy completed his treatment, and he eventually made a full recovery. The third patient was a 15-month-old boy with a 2-week history of anaemia, who was diagnosed with a non- classified malignant sarcoma with undifferentiated rhabdoid components. Evidence of bleeding prompted an exploratory laparotomy, which revealed a non-resectable tumour with metastases. He received ifosfamide, vincristine and dactinomycin (CWS-96 protocol) [dosages not stated]. The following day he developed intraperitoneal haemorrhage. His haemoglobin dropped to 87 g/L and his platelet count increased to 714 × 10 9 /L. He was transferred to the ICU for treatment of abdominal haemorrhage, haemorrhagic shock, restrictive respiratory insufficiency and acute pulmonary oedema with pulmonary haemorrhage. Chemotherapy was restarted once his condition stabilised. On the following day, however, he developed progressive intraperitoneal bleeding and his clinical condition deteriorated. He received blood 1 Reactions 27 Feb 2010 No. 1290 0114-9954/10/1290-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1290 - 27 Feb 2010
transfusions in addition to eptacog alfa twice daily for11 days. His coagulation parameters remained mostly SAntineoplasticsnormal during eptacog alfa therapy. His recovery was slowover the next 3 weeks, but there were no signs of furtherHaemorrhage in paediatric patients, treated withbleeding, so his chemotherapy was continued. During theeptacog alfa: 3 case reportsnext cycle, haemorrhage recurred but was partiallyThree paediatric patients developed haemorrhage duringcontrolled with eptacog alfa. He eventually died fromchemotherapy for various malignancies.multiple organ failure.The first patient was a full-term male neonate who had
severe hepatomegaly on the first day of life. After his liver Bilic E, et al. Recombinant activated factor VII controls chemotherapy-relatedhemorrhage in patients with solid intra-abdominal tumors: A report of threebiopsy showed hepatoblastoma, he received cisplatin,pediatric cases. Acta Clinica Croatica 48: 161-166, No. 2, Jun 2009 -doxorubicin [dosages not stated], albumin and bloodCroatia 803006079products. Despite supportive therapy, his clinical and
haematological status worsened [time to reaction onset notstated]; his haemoglobin dropped to 74 g/L and his plateletcount dropped to 30 × 109/L. His prothrombin timedecreased to 0.30, and his activated partial thromboplastintime increased to 74.3 seconds. His abdominal girthincreased from 44 to 48cm; a CT scan showedintraperitoneal haemorrhage. He started to show signs ofoedema and tachycardia, with imminent cardiorespiratoryinsufficiency. Supportive therapy temporarily improved hiscondition but his bleeding continued. Treatment witheptacog alfa [recombinant factor VIIa] resulted in completecessation of bleeding and significant clinical improvement.His bleeding parameters improved and his abdominal girthdecreased to 47cm. Blood transfusions were discontinued.After the last cycle of chemotherapy, a CT scan showedregression of the tumour. He was then referred for surgeryand made a full recovery after 3 years.
The second patient was an 8-year-old boy who had a3-week history of abdominal pain and vomiting; he wasdiagnosed with embryonic rhabdomyosarcoma. After hisfirst cycle of ifosfamide/vincristine/dactinomycin therapy[dosages and time to reaction onset not clearly stated], hedeveloped severe bone marrow aplasia, bilateralpneumonia, pulmonary oedema, sepsis, multi-organdysfunction syndrome and severe intraabdominal bleeding.He received blood transfusions but the bleeding persisted.On the third day after the first chemotherapy cycle, he hadpersistent GI bleeding, melena, and haematemesis. Anultrasound showed fluid accumulation within theabdominal cavity. He received eptacog alfa at 3-hourintervals which temporarily stopped the bleeding. He wastransferred to the ICU where he received four more doseseptacog alfa over the next 2 days. His bleeding stoppedafter the second day of eptacog alfa. He was then treatedfor iatrogenic bone marrow aplasia, sepsis and bilateralpneumonia. Three weeks after ICU admission, hiscondition stabilised and chemotherapy was continued withthe same agents. After debulking surgery and three morecycles of chemotherapy, the tumour became undetectable.Radiotherapy completed his treatment, and he eventuallymade a full recovery.
The third patient was a 15-month-old boy with a 2-weekhistory of anaemia, who was diagnosed with a non-classified malignant sarcoma with undifferentiatedrhabdoid components. Evidence of bleeding prompted anexploratory laparotomy, which revealed a non-resectabletumour with metastases. He received ifosfamide,vincristine and dactinomycin (CWS-96 protocol) [dosagesnot stated]. The following day he developed intraperitonealhaemorrhage. His haemoglobin dropped to 87 g/L and hisplatelet count increased to 714 × 109/L. He was transferredto the ICU for treatment of abdominal haemorrhage,haemorrhagic shock, restrictive respiratory insufficiencyand acute pulmonary oedema with pulmonaryhaemorrhage. Chemotherapy was restarted once hiscondition stabilised. On the following day, however, hedeveloped progressive intraperitoneal bleeding and hisclinical condition deteriorated. He received blood
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Reactions 27 Feb 2010 No. 12900114-9954/10/1290-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
