Life-threatening neuropathy and hepatotoxicity in infants during induction therapy for acute lymphoblastic leukemia

摘要: I N D U C T t O of a hematologic remission is now achieved in nearly 95% cases acute lymphoblastic leukemia by using standard combination Of vinca alkaloid (vincristine), prednisone , and third agent, usually L-asparaginase o r adriamycin. 1 Toxicity minimal represents less than 1% deaths during induction? The doses these agents, based on body surface area calculation, have been determined through extensive clinical testing utilizing both children adults. Two young patients developed life-threatening neuropathy hepatotoxicity after administration this ALL chemotherapy regimen. A retrospective review all infants with seen at the University Minnesota Hospitals over two-year period Was then performed to determine if profound toxicity observed two had other receiving induction therapy for ALL. results suggest that accepted chemotherapeutic agents used infants, especially vincristine, are excessive unacceptable may occur. CASE REPORTS Patient l, 16-month-old girl weighing 10.1 kg, BSA 0.47 m ~, was diagnosed as having Treatment begun vincristine 1.5 mg/m ~ weekly, which equaled 0.07 mg/kg; 40 daily; 6,000 IU/m three times per week 28 daysl well methotrexate every weeks intrathecally. On day 27, patient unable move mouth sores, ileus, massive hepatosplenomegaly, flaccid paralysis. An electromyogram revealed decreased muscle responsiveness nerve stimulation, consistent vincristine-induced axonal neuropathy. Because progressive hepatic deterioration, liver biopsy performed; histologic examination showed diffuse severe fatty changes hepatocytes, focal hepatocellular necrosis, s evidenced Small collections neutrophils lobules, mild inflammatory cell infiltrate increase fibrous tissue triads. Cholestasis also present, but there no evidence o[ viral inclusions. considered be most drug-induced hepatotoxicity. After four precarious