Antineoplastics
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Reactions 1333 - 8 Jan 2011 Brummel B, et al. Complicated but successful treatment of a patient with ataxia telangiectasia and pre-B-acute lymphoblastic leukemia. Klinische Padiatrie 222: S 391-394, No. 6, 2010. Available from: URL: http://dx.doi.org/10.1055/ Antineoplastics s-0030-1267151 - Germany 803047002 Various toxicities in a child: case report A 7-year-old girl with ataxia telangiectasia developed various toxicities including fungal sepsis and thrombosis during treatment with antineoplastics [frequencies and times to reactions onset not stated]. The girl was diagnosed with pre-B acute lymphoblastic leukaemia (ALL) and began treatment with oral prednisone 60 mg/m 2 . A good response was noted and subsequent chemotherapy was initiated according to the ALL- BFM-2000 protocol. For phase 1 of induction, vincristine (standard dose (SD) 1.5 mg/m 2 ), daunorubicin (SD 30 mg/m 2 ) and asparaginase (SD 5000 IE/m 2 ) were administered at 50% of the standard dose, then increased to 66% on day 20 or 22 [routes not stated]. Phase 2 of induction consisted of cytarabine (SD 75 mg/m 2 ), cyclophosphamide (SD 1000 mg/m 2 ) and mercaptopurine (SD 60 mg/m 2 ) given at 50% of the standard dose [routes not stated]. Cytarabine was increased to 66% for the third block on day 45, then 75% for the last block on day 59. Mercaptopurine was administered at 66% from day 45 until the end of phase 2 of induction. Intrathecal methotrexate 10–12mg was administered regularly throughout both induction phases. The only reported complication was marginal gastroenteritis. Following this, four doses of IV methotrexate 1000 mg/m 2 were administered, as well as oral mercaptopurine 25 mg/m 2 and intrathecal methotrexate 12mg. A 7-day delay in her final methotrexate dose was required on account of persistent neutropenia. Mercaptopurine therapy had been interrupted at this time. Reinduction chemotherapy was subsequently started with dexamethasone 10 mg/m 2 , doxorubicin 20 mg/m 2 [routes not stated], vincristine 1.5 mg/m 2 and asparaginase 10 000 IE/m 2 , followed by tioguanine 60 mg/m 2 [route not stated], cyclophosphamide 250 mg/m 2 , cytarabine 75 mg/m 2 and intrathecal methotrexate 12mg. Treatment was complicated by neutropenia, clinical pneumonia and Candida pelliculosa sepsis. Antifungals were commenced and her Broviac catheter was removed. The girl’s clinical condition stabilised intermittently, but she then developed mutism and generalised seizures. On an MRI scan, lesions were observed in her basal ganglia and pons. Parainfectious encephalitis was suspected. She remained under continuous antifungal and antibacterial therapy and her condition progressively improved over the following days, although mutism persisted for several weeks. Chemotherapy was delayed by 8 weeks on account of persistent Candida pneumonia. On resuming chemotherapy, she received dexamethasone 10 mg/m 2 , vincristine 1.5 mg/m 2 , doxorubicin 20 mg/m 2 and asparaginase 10 000 IE/m 2 . She subsequently developed left subclavian venous thrombosis; she was also experiencing ongoing pulmonary infections and mutism. Further chemotherapy with tioguanine, cyclophosphamide, cytarabine and methotrexate was cancelled. Thrombosis improved with enoxaparin sodium therapy, and her mutism and pulmonary infection gradually resolved. She later received maintenance therapy, which was interrupted on several occasions due to bronchitis. One year after finishing maintenance therapy, she remained in complete remission. Author comment: "Despite this significant adaptation of therapy, it has to be acknowledged that this reduced therapy has still been associated with severe and even life-threatening complications such as fungal sepsis." 1 Reactions 8 Jan 2011 No. 1333 0114-9954/10/1333-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1333 - 8 Jan 2011Brummel B, et al. Complicated but successful treatment of a patient with ataxiatelangiectasia and pre-B-acute lymphoblastic leukemia. Klinische Padiatrie 222:
S 391-394, No. 6, 2010. Available from: URL: http://dx.doi.org/10.1055/Antineoplasticss-0030-1267151 - Germany 803047002
Various toxicities in a child: case reportA 7-year-old girl with ataxia telangiectasia developed
various toxicities including fungal sepsis and thrombosisduring treatment with antineoplastics [frequencies andtimes to reactions onset not stated].
The girl was diagnosed with pre-B acute lymphoblasticleukaemia (ALL) and began treatment with oral prednisone60 mg/m2. A good response was noted and subsequentchemotherapy was initiated according to the ALL-BFM-2000 protocol. For phase 1 of induction, vincristine(standard dose (SD) 1.5 mg/m2), daunorubicin (SD30 mg/m2) and asparaginase (SD 5000 IE/m2) wereadministered at 50% of the standard dose, then increasedto 66% on day 20 or 22 [routes not stated]. Phase 2 ofinduction consisted of cytarabine (SD 75 mg/m2),cyclophosphamide (SD 1000 mg/m2) and mercaptopurine(SD 60 mg/m2) given at 50% of the standard dose [routesnot stated]. Cytarabine was increased to 66% for the thirdblock on day 45, then 75% for the last block on day 59.Mercaptopurine was administered at 66% from day 45 untilthe end of phase 2 of induction. Intrathecal methotrexate10–12mg was administered regularly throughout bothinduction phases. The only reported complication wasmarginal gastroenteritis. Following this, four doses of IVmethotrexate 1000 mg/m2 were administered, as well asoral mercaptopurine 25 mg/m2 and intrathecalmethotrexate 12mg. A 7-day delay in her final methotrexatedose was required on account of persistent neutropenia.Mercaptopurine therapy had been interrupted at this time.Reinduction chemotherapy was subsequently started withdexamethasone 10 mg/m2, doxorubicin 20 mg/m2 [routesnot stated], vincristine 1.5 mg/m2 and asparaginase10 000 IE/m2, followed by tioguanine 60 mg/m2 [route notstated], cyclophosphamide 250 mg/m2, cytarabine75 mg/m2 and intrathecal methotrexate 12mg. Treatmentwas complicated by neutropenia, clinical pneumonia andCandida pelliculosa sepsis.
Antifungals were commenced and her Broviac catheterwas removed. The girl’s clinical condition stabilisedintermittently, but she then developed mutism andgeneralised seizures. On an MRI scan, lesions wereobserved in her basal ganglia and pons. Parainfectiousencephalitis was suspected. She remained undercontinuous antifungal and antibacterial therapy and hercondition progressively improved over the following days,although mutism persisted for several weeks.Chemotherapy was delayed by 8 weeks on account ofpersistent Candida pneumonia. On resumingchemotherapy, she received dexamethasone 10 mg/m2,vincristine 1.5 mg/m2, doxorubicin 20 mg/m2 andasparaginase 10 000 IE/m2. She subsequently developedleft subclavian venous thrombosis; she was alsoexperiencing ongoing pulmonary infections and mutism.Further chemotherapy with tioguanine,cyclophosphamide, cytarabine and methotrexate wascancelled. Thrombosis improved with enoxaparin sodiumtherapy, and her mutism and pulmonary infection graduallyresolved. She later received maintenance therapy, whichwas interrupted on several occasions due to bronchitis.One year after finishing maintenance therapy, sheremained in complete remission.
Author comment: "Despite this significant adaptation oftherapy, it has to be acknowledged that this reduced therapyhas still been associated with severe and even life-threateningcomplications such as fungal sepsis."
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Reactions 8 Jan 2011 No. 13330114-9954/10/1333-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
