ABSTRACT
Tumor lysis syndrome rarely occurs during chemotherapy treatment of indolent lymphoid tumors. This report describes for the first time a case of acute tumor lysis syndrome complicating fludarabine treatment of prolymphocytic leukemia. In this particular case the patient had an unexpectedly rapid response to fludarabine 15 days after initiation of the first chemotherapy cycle, which was subsequently complicated by the development of tumor lysis syndrome. Until more data are known concerning fludarabine treatment of prolymphocytic leukemia, cautious monitoring of patients treated with fludarabine should be undertaken, even after completion of the chemotherapy course.
Subject(s)
Antineoplastic Agents/adverse effects , Leukemia, Prolymphocytic/drug therapy , Tumor Lysis Syndrome/etiology , Vidarabine/analogs & derivatives , Acute Disease , Aged , Antineoplastic Agents/therapeutic use , Fatal Outcome , Female , Humans , Leukemia, Prolymphocytic/physiopathology , Tumor Lysis Syndrome/physiopathology , Vidarabine/adverse effects , Vidarabine/therapeutic useSubject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Leukemia, Myeloid, Acute/drug therapy , Adult , Aged , Antibiotics, Antineoplastic/administration & dosage , Cytarabine/administration & dosage , Female , Humans , Leukemia, Myeloid, Acute/mortality , Male , Middle Aged , Remission Induction , Retrospective Studies , Thioguanine/administration & dosageABSTRACT
Avascular necrosis of bone developed in eight patients with advanced Hodgkin's disease who had been treated with combined modality therapy and were in complete remission from their disease. A ninth patient not on protocol but treated with the combined modality program also developed avascular necrosis. The cumulative incidence was 10% among long-term survivors. The etiology is unclear. Prolonged corticosteroid administration has been implicated but usually in much larger doses than the patients in this series received. The possible roles of the other chemotherapeutic agents for Hodgkin's disease, and radiation are discussed. Considerable disability resulted for almost all patients. Three of seven patients primarily with avascular necrosis of the femoral heads had bilateral hip replacements with surgery anticipated in four others. The two patients primarily with humeral head involvement have limited use of their arms. This condition must be added to the known possible serious consequences of combination chemotherapy for Hodgkin's disease. It is uncertain if the frequency of avascular necrosis is higher in patients treated with both radiation and chemotherapy compared with chemotherapy alone. Further studies are needed from other institutions to clarify the frequency and cause of this problem.
Subject(s)
Antineoplastic Agents/administration & dosage , Hodgkin Disease/therapy , Osteonecrosis/etiology , Adult , Drug Therapy, Combination , Female , Femur Head Necrosis/etiology , Hodgkin Disease/complications , Hodgkin Disease/mortality , Humans , Male , Mechlorethamine/administration & dosage , Middle Aged , Prednisone/administration & dosage , Procarbazine/administration & dosage , Radiotherapy Dosage , Risk , Vinblastine/administration & dosage , Vincristine/administration & dosageABSTRACT
A 70-year-old man experienced pure RBC aplasia after high-dose chlorpropamide therapy. This is the second reported case of pure RBC aplasia associated with chlorpropamide. Cessation of the drug therapy was followed by rapid and sustained complete return to a normal hemoglobin level. A brief review of pure RBC aplasia is presented.
Subject(s)
Anemia, Aplastic/chemically induced , Chlorpromazine/adverse effects , Erythropoiesis/drug effects , Aged , Humans , MaleABSTRACT
Forty-eight women with advanced metastatic carcinoma of the breast were treated with one of two combination chemotherapy regimens: 1) adriamycin and cyclophosphamide or 2) adriamycin, cyclophosphamide, methotrexate and 5-fluorouracil. The response rate in the two-drug treatment group was 50% and in the four-drug treatment group, 55%. The median duration of response was ten months in both treatment groups. Dramatic responses were seen in patients with visceral metastases. Patients who responded to chemotherapy had a significantly longer survival than nonresponders (p less than 0.01). The long interval between adriamycin doses (six weeks) in the four drug regimen did not adversely effect the response rate--an important finding in view of the dose-related cardiac toxicity of this agent.
Subject(s)
Antineoplastic Agents/therapeutic use , Breast Neoplasms/drug therapy , Doxorubicin/therapeutic use , Adult , Aged , Bone Marrow/drug effects , Cyclophosphamide/adverse effects , Cyclophosphamide/therapeutic use , Digestive System/drug effects , Doxorubicin/administration & dosage , Doxorubicin/adverse effects , Drug Administration Schedule , Drug Therapy, Combination , Female , Fluorouracil/adverse effects , Fluorouracil/therapeutic use , Humans , Methotrexate/adverse effects , Methotrexate/therapeutic use , Middle Aged , Neoplasm Metastasis/drug therapy , Remission, Spontaneous , Time FactorsABSTRACT
Over a 19-year period, a patient with polycythemia vera who had undergone a splenectomy received six courses of busulfan for recurrent thrombocytosis. The total dose of busulfan given for the sixth course was greater than that used for the previous ones. Severe pancytopenia followed, which persisted for 4 months. During this period there was marked erythroid hyperplasia in the bone marrow with striking dyserythropoiesis; PAS-positive red cell precursors, as well as moderate numbers of circulating normoblasts and evidence of chronic and acute hemolysis, were present. All of these findings reverted to normal without therapy, and the polycythemic state eventually recurred. These events are interpreted as an unusual marrow reaction following busulfan overdosage rather than a transient erythroleukemia.
