Antineoplastics
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Reactions 1395 - 31 Mar 2012 X S Antineoplastics Lung failure in a child: case report A 3-year-old child [sex not stated] with metastatic intracranial grade IV medulloblastoma developed lung failure after receiving antineoplastics. The child had undergone resection of the cerebral mass, and received high-dose chemotherapy according to the HIT 2000 MET-BIS4 protocol, consisting of carboplatin, cyclophosphamide, etoposide phosphate and thiotepa [dosages, routes and duration of treatment not stated], without radiotherapy. The child also received autologous stem cell therapy but this did not result in clinical remission. The child developed acute respiratory distress syndrome, requiring intubation and ventilation [time to reaction onset not stated]. Bronchoalveolar lavage (BAL) revealed persistent granulocytic inflammation. Chemotherapy-related respiratory insufficiency was suspected because the child could not be weaned from ventilation. There was no improvement despite high-frequency oscillation ventilation and high-dose corticosteroid therapy, and the child developed recurrent pneumothorax, mediastinal emphysema and recurrent respiratory failure with hypercapnia requiring resuscitation. The child was transferred to a clinic for paediatric surgery and received venovenous extracorporeal membrane oxygenation (ECMO), which resulted in normocapnia. The child then became clinically stable. Chest x-rays showed signs of a white lung, and laboratory investigations revealed elevated inflammatory parameters. BAL fluid showed atypical cells, which were considered to be due to chemotherapy-related lung damage, based on histopathology following thoracoscopic lung biopsy performed during ECMO. Therapy was discontinued, and the child died 3 days after the operation. Author comment: "[T]he suspicious cells were accepted as a reactive alteration due to chemotherapy. Therefore, lung failure was due to chemotherapy and long-term ventilation." Zoeller C, et al. Thoracoscopic lung biopsy during venovenous extracorporeal membrane oxygenation in childhood. European Journal of Pediatric Surgery 21: 274-5, No. 4, Aug 2011 - Germany 803068459 1 Reactions 31 Mar 2012 No. 1395 0114-9954/10/1395-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1395 - 31 Mar 2012
X SAntineoplastics
Lung failure in a child: case reportA 3-year-old child [sex not stated] with metastatic
intracranial grade IV medulloblastoma developed lungfailure after receiving antineoplastics.
The child had undergone resection of the cerebral mass,and received high-dose chemotherapy according to the HIT2000 MET-BIS4 protocol, consisting of carboplatin,cyclophosphamide, etoposide phosphate and thiotepa[dosages, routes and duration of treatment not stated],without radiotherapy. The child also received autologousstem cell therapy but this did not result in clinicalremission. The child developed acute respiratory distresssyndrome, requiring intubation and ventilation [time toreaction onset not stated]. Bronchoalveolar lavage (BAL)revealed persistent granulocytic inflammation.Chemotherapy-related respiratory insufficiency wassuspected because the child could not be weaned fromventilation.
There was no improvement despite high-frequencyoscillation ventilation and high-dose corticosteroidtherapy, and the child developed recurrent pneumothorax,mediastinal emphysema and recurrent respiratory failurewith hypercapnia requiring resuscitation. The child wastransferred to a clinic for paediatric surgery and receivedvenovenous extracorporeal membrane oxygenation(ECMO), which resulted in normocapnia. The child thenbecame clinically stable. Chest x-rays showed signs of awhite lung, and laboratory investigations revealed elevatedinflammatory parameters. BAL fluid showed atypical cells,which were considered to be due to chemotherapy-relatedlung damage, based on histopathology followingthoracoscopic lung biopsy performed during ECMO.Therapy was discontinued, and the child died 3 days afterthe operation.
Author comment: "[T]he suspicious cells were accepted asa reactive alteration due to chemotherapy. Therefore, lungfailure was due to chemotherapy and long-term ventilation."Zoeller C, et al. Thoracoscopic lung biopsy during venovenous extracorporealmembrane oxygenation in childhood. European Journal of Pediatric Surgery 21:274-5, No. 4, Aug 2011 - Germany 803068459
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Reactions 31 Mar 2012 No. 13950114-9954/10/1395-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
