ABSTRACT
Sinusoidal obstruction syndrome, a complication occurring early after hematopoietic stem cell transplantation, is a concern for clinicians. There are no guidelines to direct clinicians on the optimal way to prevent and treat this disease. Newer data show that defibrotide is a promising drug both for prevention and treatment, although it is not yet FDA approved.
Subject(s)
Hematopoietic Stem Cell Transplantation/adverse effects , Hepatic Veno-Occlusive Disease/prevention & control , Pre-Exposure Prophylaxis/standards , Adult , Child , Fibrinolytic Agents/administration & dosage , Hepatic Veno-Occlusive Disease/diagnosis , Hepatic Veno-Occlusive Disease/etiology , Humans , Polydeoxyribonucleotides/administration & dosage , Pre-Exposure Prophylaxis/methods , Randomized Controlled Trials as Topic/methodsSubject(s)
Bone Marrow Transplantation/adverse effects , Cryoprotective Agents/adverse effects , Dimethyl Sulfoxide/adverse effects , Myocardial Infarction/chemically induced , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Adult , Bone Marrow Cells , Cryopreservation , Glucosephosphate Dehydrogenase Deficiency/complications , Humans , Male , Myocardial Infarction/diagnosis , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Transplantation, HomologousABSTRACT
Ifosfamide is an alkylating agent used to treat different types of malignancies including lymphomas, sarcomas and germinal cell tumors. Symptoms of ifosfamide neurotoxicity can range from mild confusion, dizziness and hallucination to overt encephalopathy. Various treatment options like methylene blue, albumin infusion and rarely hemodialysis have been used to treat ifosfamide neurotoxicity. We hereby report a case of a patient with relapsed diffuse large B cell lymphoma who received methylene blue after experiencing acute renal failure and encephalopathy due to ifosfamide with no improvement. The prompt use of hemodialysis in this case has led to reversal of both renal failure and neurotoxicity.
Subject(s)
Acute Kidney Injury/chemically induced , Antineoplastic Agents, Alkylating/adverse effects , Brain Diseases/chemically induced , Ifosfamide/adverse effects , Acute Kidney Injury/therapy , Aged , Antineoplastic Agents, Alkylating/therapeutic use , Brain Diseases/therapy , Humans , Ifosfamide/therapeutic use , Lymphoma, Large B-Cell, Diffuse/drug therapy , Male , Renal Dialysis/methodsABSTRACT
INTRODUCTION: Cetuximab is a chimeric mouse-human (30:70) IgG1 monoclonal antibody that competitively inhibits the binding of epidermal growth factor. Cetuximab is generally well tolerated; however, hypersensitivity infusion reactions have been reported. The incidence at the University of Oklahoma was currently unknown, though anecdotally high. The purpose of this study was to determine the incidence of severe HIRs and secondarily to determine risk factors for cetuximab-induced hypersensitivity infusion reactions. METHODS AND RESULTS: A retrospective chart review was conducted and included all patients that received cetuximab from 2005 to 2010 at the outpatient clinics of the Oklahoma University Health Sciences Center. A total of 153 patients were included in the analysis. The overall incidence proportion of severe hypersensitivity infusion reactions was 12.4%. Male patients had an increased incidence of severe hypersensitivity infusion reactions compared to female patients (20.6% vs. 5%, p = 0.0036). Current smokers had an increased incidence of severe hypersensitivity infusion reactions of 23.6% when compared to never smokers or former smokers, p = 0.0012. Cervical cancer had a significantly decreased risk of severe hypersensitivity infusion reactions when compared to other tumor types (5.3% vs. 16.7%, p = 0.0387). Multivariate analysis identified risk factors associated with severe HIRs to be: male gender, RR = 3.9, p = 0.01 and current smokers, RR = 3.98, p = 0.0048. CONCLUSION: Patients at the University of Oklahoma had an increased incidence of severe hypersensitivity infusion reactions when compared to the national average. Male patients and current smokers were found to be at increased risk for severe hypersensitivity infusion reactions in our study. Further investigation is warranted.
Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Antibodies, Monoclonal, Humanized/therapeutic use , Drug Hypersensitivity/etiology , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/adverse effects , Antineoplastic Agents/therapeutic use , Cetuximab , Female , Humans , Incidence , Infusions, Intravenous , Male , Middle Aged , Retrospective Studies , Risk Factors , Young AdultABSTRACT
Atrial fibrillation (AF) results in nearly a quarter of the strokes suffered in patients 80 to 89 years of age. Aspirin and warfarin are primary choices for preventing these ischemic strokes. CHADS2 (Congestive heart failure, Hypertention, Age, Diabetes, Stroke) is a validated assessment tool for cardioembolic stroke in AF. Ischemic stroke rates increase from 1.9 to 18.2 events per 100 patient-years with CHADS2 scores of 0 and 6, respectively. Warfarin is more effective than aspirin at preventing stroke in AF, but is associated with more hemorrhagic events. The American College of Chest Physicians recommends the use of warfarin in patients with a CHADS2 score of 2 or higher and suggests warfarin be used in patients with a score of 1. We recommend a patient-specific approach to therapy in which warfarin is offered to patients with a CHADS2 score of 1 or higher unless the patient is at high risk for a hemorrhagic event or cannot attain regular warfarin monitoring.
