Temozolomide
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Haematologic and nonhaematologic toxicities: 5 case reports A study involving seven haemodialysis patients who were diagnosed with high grade glioma, described five men, aged 57–80 years, who developed lymphopenia, thrombocytopenia and neutropenia (1 patient), lymphopenia and bacterial pneumonia (1 patient), lymphopenia and pneumonia due to Methicillin-resistant Staphylococcus aureus infection (1 patient), lymphopenia and leukoencephalopathy (1 patient) or skin rash (1 patient) during treatment with temozolomide for glioblastoma [durations of treatments to reactions onsets not stated; not all outcomes stated]. The 5 men, who had been receiving haemodialysis, were diagnosed with glioblastoma not otherwise specified (1 patient) or glioblastoma (4 patients). Subsequently, the men underwent gross total resection (3 patients), subtotal resection (1 patient) or partial resection (1 patient). Thereafter, all the 5 men started receiving concomitant radiation and oral temozolomide 75 mg/m2 (chemoradiotherpy). During concomitant chemoradiotherapy, four men developed lymphopenia grade 3 (n=2) and grade 4 (n=2). One of the men with grade 3 lymphopenia additionally developed grade 3 thrombocytopenia and one of the men with grade 4 lymphopenia additionally developed grade 2 bacterial pneumonia (not caused by Pneumocystis-pneumonia), which can not be correlated with lymphopenia between day 28 and day 42 of temozolomide therapy. The another man developed grade 3 skin rash (skin eruption). The man who developed skin rash, discontinued temozolomide after the 10th day of the concomitant therapy, while the bacterial pneumonia was treated with 1 week course of unspecified antibacterials. In three of these patients lymphopenia resolved spontaneously; while the remaining one patient required temporary discontinuation of temozolomide for 3 days to allow recovery from myelotoxicity. Recovery upto grade 3 lymphopenia was documented. After improvement to grade 3 lymphopenia, temozolomide was restarted at the same dose. The men received temozolomide for 10–42 days during concomitant chemoradiotherapy. After completion of concomitant chemoradiotherapy, four men started receiving adjuvant chemotherapy with temozolomide 150 mg/m2 for 5 days, every 28 days. The men received 3–12 cycles of temozolomide. During the course of adjuvant chemotherapy, the men developed grade 3 lymphopenia (n=2). One of these two men additionally developed grade 3 neutropenia. The man with only lymphopenia during adjuvant monotherapy did not require decrease in the temozolomide dose. Of the remaining two men, one man developed bacterial pneumonia secondary to Methicillin-resistant Staphylococcus aureus infection after 3 cycles of temozolomide and eventually died of it; while the remaining man developed grade 3 leukoencephalopathy (n=1). Additionally, two of these men died due to causes like asthenia and aspiration pneumonia (the man who developed leukoencephalopathy) or various infections (the man who developed skin rash), which were determined to be unrelated to t
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