Antineoplastics
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Reactions 1243 - 14 Mar 2009 S Antineoplastics Hepatic veno-occlusive disease in an infant, successfully treated with methylprednisolone: case report A 21-month-old boy developed hepatic veno-occlusive disease during treatment with alternating cycles of vincristine, dactinomycin and cyclophosphamide (VAC) and vincristine, etoposide and ifosfamide (VEI). Subsequent treatment including high-dose methylprednisolone was successful. The boy was diagnosed with rhabdomyosarcoma. He began chemotherapy consisting of vincristine 1.5 mg/m 2 /day on day 1, dactinomycin 0.5 mg/m 2 /day on days 1–5, and cyclophosphamide 2.2 g/m 2 /day on day 1 and alternating vincristine 1.5 mg/m 2 /day on day 1, etoposide 100 mg/m 2 /day on days 1–5 and ifosfamide 1.8 g/m 2 /day on days 1–5, administered every 3 weeks. The first courses of VAC and VEI were remarkable only for the development of pancytopenia and neutropenic fever. On the third day (day +8 from the start of chemotherapy) after completing the second course of the VAC regimen, he developed fever and abdominal distension. Complete blood count revealed pancytopenia; he also had a haemoglobin level of 9.6 g/dL and a CRP level of 2.8 mg/dL. A right sided pleural effusion was evident upon chest x-ray. After septic work-up, he received empiric antibiotics. On day +11, his condition rapidly worsened and he was transferred to the ICU. His bodyweight had increased by > 10% and he had a WBC count of < 200/mm 3 , a haemoglobin level of 6.0 g/dL, a platelet count of 1000/mm 3 , an AST level of 118 U/L, an ALT level of 54 U/L, total and direct bilirubin levels of 1.1 and 0.51 g/dl, respectively, A BUN of < 1 mg/dL, a creatinine level of 0.2 mg/dL, a chloride level of 102 mmol/L and an albumin level of 3 g/dL. His prothrombin time was 13.7 seconds with an INR of 1.29 and a D-dimer level of 1987 µg/L. He had a pH of 7.457, a pCO2 of 44.6mm Hg, a pO2 of 59.4mm Hg, a bicarbonate level of 30.8 mmol/L and oxygen saturation of 91.9%, with a 50% O2 hood in use. A repeat chest x-ray showed lower lung infiltration with pleural effusion bilaterally. Hepatomegaly and massive ascites were observed during abdominal ultrasonography. His condition failed to improve despite blood component replacement, fluid restriction and diuretics. Hepatic veno-occlusive disease was diagnosed and, beginning on the evening of day+12, the boy began receiving methylprednisolone 15 mg/kg, every 12 hours for six doses. By day +15 his ALT, AST, total bilirubin, BUN and CRP levels, as well as his prothrombin time had increased further; however, his condition gradually improved thereafter. By day +20 AST, ALT and total bilirubin were 91 U/L, 197 U/L and 1.4 g/dL, respectively. No sequelae of venous-obstructive disease were noted. Following normalisation of laboratory results and improvement of his general condition VAC was replaced with vincristine, epirubicin and cyclophosphamide (VEC). Up to completion of a 1-year course of chemotherapy, liver function tests and abdominal ultrasonography remained normal. Chen I-L, et al. Treatment with High-dose Methylprednisolone for Hepatic Veno- occlusive Disease in a Child with Rhabdomyosarcoma. Pediatrics & Neonatology 49: 141-144, No. 4, Aug 2008 - Taiwan 801132207 1 Reactions 14 Mar 2009 No. 1243 0114-9954/10/1243-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1243 - 14 Mar 2009
SAntineoplastics
Hepatic veno-occlusive disease in an infant,successfully treated with methylprednisolone:case report
A 21-month-old boy developed hepatic veno-occlusivedisease during treatment with alternating cycles ofvincristine, dactinomycin and cyclophosphamide (VAC)and vincristine, etoposide and ifosfamide (VEI).Subsequent treatment including high-dosemethylprednisolone was successful.
The boy was diagnosed with rhabdomyosarcoma. Hebegan chemotherapy consisting of vincristine1.5 mg/m2/day on day 1, dactinomycin 0.5 mg/m2/day ondays 1–5, and cyclophosphamide 2.2 g/m2/day on day 1and alternating vincristine 1.5 mg/m2/day on day 1,etoposide 100 mg/m2/day on days 1–5 and ifosfamide1.8 g/m2/day on days 1–5, administered every 3 weeks. Thefirst courses of VAC and VEI were remarkable only for thedevelopment of pancytopenia and neutropenic fever. Onthe third day (day +8 from the start of chemotherapy) aftercompleting the second course of the VAC regimen, hedeveloped fever and abdominal distension. Completeblood count revealed pancytopenia; he also had ahaemoglobin level of 9.6 g/dL and a CRP level of 2.8 mg/dL.A right sided pleural effusion was evident upon chest x-ray.After septic work-up, he received empiric antibiotics. Onday +11, his condition rapidly worsened and he wastransferred to the ICU. His bodyweight had increased by> 10% and he had a WBC count of < 200/mm3, ahaemoglobin level of 6.0 g/dL, a platelet count of1000/mm3, an AST level of 118 U/L, an ALT level of 54 U/L,total and direct bilirubin levels of 1.1 and 0.51 g/dl,respectively, A BUN of < 1 mg/dL, a creatinine level of0.2 mg/dL, a chloride level of 102 mmol/L and an albuminlevel of 3 g/dL. His prothrombin time was 13.7 secondswith an INR of 1.29 and a D-dimer level of 1987 µg/L. Hehad a pH of 7.457, a pCO2 of 44.6mm Hg, a pO2 of59.4mm Hg, a bicarbonate level of 30.8 mmol/L andoxygen saturation of 91.9%, with a 50% O2 hood in use. Arepeat chest x-ray showed lower lung infiltration withpleural effusion bilaterally. Hepatomegaly and massiveascites were observed during abdominal ultrasonography.His condition failed to improve despite blood componentreplacement, fluid restriction and diuretics.
Hepatic veno-occlusive disease was diagnosed and,beginning on the evening of day+12, the boy beganreceiving methylprednisolone 15 mg/kg, every 12 hours forsix doses. By day +15 his ALT, AST, total bilirubin, BUN andCRP levels, as well as his prothrombin time had increasedfurther; however, his condition gradually improvedthereafter. By day +20 AST, ALT and total bilirubin were91 U/L, 197 U/L and 1.4 g/dL, respectively. No sequelae ofvenous-obstructive disease were noted. Followingnormalisation of laboratory results and improvement of hisgeneral condition VAC was replaced with vincristine,epirubicin and cyclophosphamide (VEC). Up to completionof a 1-year course of chemotherapy, liver function tests andabdominal ultrasonography remained normal.Chen I-L, et al. Treatment with High-dose Methylprednisolone for Hepatic Veno-occlusive Disease in a Child with Rhabdomyosarcoma. Pediatrics & Neonatology49: 141-144, No. 4, Aug 2008 - Taiwan 801132207
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Reactions 14 Mar 2009 No. 12430114-9954/10/1243-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
