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PP-081 SEVERE RENAL FAILURE DUE TO HIGH DOSE METHOTREXATE IN ACUTE LYMPHOBLASTIC LEUKEMIA ASSOCIATED WITH PREDISPOSING FACTORS: CASE REPORT
Poster Presentations – Vth International Eurasian Hematology Congress / Leukemia Research 38 S1 (2014) S1–S65
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PP-081 SEVERE RENAL FAILURE DUE TO HIGH DOSE METHOTREXATE IN ACUTE LYMPHOBLASTIC LEUKEMIA ASSOCIATED WITH PREDISPOSING FACTORS: CASE REPORT 1
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M. Dagli , A. Basturk , L. Kutlucan , B. Copur , A. Kutlucan , F. Sahin . 1 Selcuk University, School of Medicine, Department of Hematology, Konya, Turkey; 2 Department of Hematology, Konya Training and Research Hospital, Konya, Turkey; 3 Department of Anesthesiology, Konya Training and Research Hospital, Konya, Turkey
dose chemotherapy and stem cell transplantation patients with delayed engraftment and persistent fever. PP-083 SECONDARY ALL IN MULTIPLE MYELOMA PATIENT WHO UNDERWENT HDC AND SCT S. Ozaydin, S. Ataergin, M. Ozturk, N. Karadurmus, G. Erdem, F. Arpaci. GATA Medical Oncology Clinic
Introduction: High dose methotrexate induced acute tubular damages is an important oncologic emergency in spite of preventive supportive treatment such as closely monitoring, leucovorin, hydration and alkalization. We report a case of severe renal insufficiency due to Hyper-CVAD in an acute lymphoblastic leukemia (ALL) with contributing factors such as diabetes and hypertension. Case: Hyper-CVAD was started to a 45 years old male ALL patient. He had diagnosis of diabetes mellitus and hypertension previously. After high-dose methotrexate infusion, preventive treatments such as adequate hydration and optimal dose folinic acid were given. Initially, the value of creatinine was 0.82 mg/dL. Despite preventive treatment, on the twelfth day of chemotherapy, creatinine value began to increase rapidly and acute renal failure occurred. Creatinine increased to 7.76 mg/dL and he became anuric. Dialysis and adequate supportive treatments were started immediately. He was monitored in the intensive care unit because of worsening of general condition. On the eighth day of acute renal failure the patient’s urine output has begun and septic shock improved during the course. The patient was discharged eventually. Discussion: High-dose methotrexate induced acute renal failure is a rare condition according to the other side effects of methotrexate. This rare side effect, in the presence of underlying predisposing factors may be more frequent and more severe. As in our case, even at normal creatinine values, while applying high-dose methotrexate we believe patients must be monitored closely for toxicity, adequate dose and duration of preventive treatment must be done and if possible dose adjustment would be appropriate especially in the presence of predisposing conditions to renal failure such as diabetes and hypertension.
Introduction: Secondary malignancies developing after chemotherapy, radiotherapy or stem cell transplantation (SCT) are mainly AML, MDS and carries severe complications and poor prognosis. ALL is a rare secondary malignancy after SCT for multiple myeloma cases. Case: A 58-year-old male with back pain was diagnosed solitary plasmocytoma on the T6 vertebra ten years ago. The evaluation confirmed multiple myeloma, IgG type and stage IIIA. Radiotherapy in to the involved area and 4 courses of VAD chemotherapy and 4 mg Zolendronic acid on a monthly schedule was given. After the completion of chemotherapy he underwent a double tandem autologous SCT of Melfalan 140 mg/m2 . After achieving a successful engraftment period, the patient continued on monthly Zoledronic acid treatment. However, 5 years ago, IgG levels progressively increased, erythrocyte sedimentation rate, CRP and serum β-2 macroglobulin levels increased as well. Thalidomide was initiated on a dose of 2×50 mg and his complaints regressed and laboratory test results were within normal ranges. The patient stopped the treatment after several years by himself. Six months ago he experienced dizziness, and syncope attacks. Laboratory examination showed abnormal results like WBC: 235,000/mm3 , hemoglobin 5.4 g/dl and Platelet: 13,000/mm3 . Peripheral blood smear showed diffuse blastic appearance. Bone marrow aspiration and biopsy confirmed ALL, which also was confirmed with flow cytometry showing excess expressions on CD10, CD19, CD34, HLA-DR and CD79a molecules. Therefore, ALL induction therapy and subsequently consolidation therapies were initiated. The patient is still in complete hematologic response and further High dose chemotherapy with allogeneic SCT is planned. Conclusion: According to the current literature, this is the second case of multiple myeloma who developed ALL as a secondary malignancy. Due to the rarity of these kinds of tumors, multinational data may provide better informational platform.
PP-082 DELAYED ENGRAFTMENT DUE TO CANDIDA NORVEGENSIS IN HDC AND SCT PATIENT
PP-084 THE OUTCOME OF HDC AND ASCT IN PATIENTS WITH RECURRENT MEDULLOBLASTOMA
S. Ozaydin, M. Ozturk, N. Karadurmus, G. Erdem, F. Arpaci. GATA Medical Oncology Clinic
S. Ozaydin, M. Ozturk, N. Karadurmus, G. Erdem, F. Arpaci. GATA Medical Oncology Clinic
Introduction: Invasive fungal infections are important causes of mortality in immunocompromised patients with hematologic malignancies. Candida infections cause about 40% of mortality and engraftment delay in patients with autologous/allogeneic stem cell transplantation. Case report: A 65-year-old lady with left axillary mass was diagnosed stage III, Diffuse Large B Cell NHL. Patient received 6 cycles of R-CHOP chemotherapy and complete remission was achieved after treatments. 3 months later, she complained about night sweats and weakness. Radiologic examination showed diffuse metastases in her liver. After 3 cycles of R-DHAP chemotherapy complete remission was achieved and high-dose chemotherapy (CEAM protocol) with autologous peripheral stem cell transplantation, in which a total of 1.9×106 /kg CD (34) cells were performed. Four days after stem cell reinfusion, fever and neutropenia developed and she received Meropenem monotherapy 1 gram by IV infusion every 8 hours. Within 48 hours fever increased and Teicoplanin was added to the treatments. Fever persisted and continue to rise and 72 hours after antibiotic treatments, Voricanazole was added to the combination. Even though wide spectrum antibiotics and antifungal agents were used fever did not reduced for five days. Candida Norvegensis was isolated from one of the peripheral blood samples and Liposomal Amphotericin B was used at 5 mg/kg per day. Due to persistent fever after Meronem, Teicoplanin and Liposomal Amphoterisin B treatment Teicoplanin was changed to Vancomycin. In addition to these drugs, caspofungin was added to the treatment. Leucocyte engraftment delayed and achieved at +21 day after stem cell reinfusion. Conclusion: This case showed that physicians must be aware of an unusual fungal infection like Candida Norvegensis and consider combination therapy if monotherapy with antifungal agents are not effective in high
Background: Medulloblastoma (MB) is the most common and very aggressive malignant embryonic brain tumor. Surgery, craniospinal irradiation and chemotherapy are the highest standard treatment used in MB. In adult patients, the five-year progression-free survival rate ranges from 45% to 75%. There is no established treatment with metastatic, unrespectable or recurrent MB. The outcome for patients with recurrent medulloblastoma is poor and most patients die usually within 12 to 15 months after retreatment with either chemotherapy or radiotherapy This study was designed to determine the efficiency and safety of high-dose chemotherapy (HDC) and stem cell transplantation (SCT) in patients with recurrent MB. Material and methods: This is a retrospective chart review of all patients with recurrent MB. Between 2004 and 2009, a total of 3 patients were treated for recurrent MB. All patients had received surgery, craniospinal irradiation and chemotherapy before relapse. Among the 3 patients, 2 complete responses and 1 partial response were observed in the followup periods. As the relapse occurred in complete response group during the follow-up period, all three patients were treated with high-dose chemotherapy followed by autologous bone marrow transplantation. The HDC consisted of carboplatin 1,200 mg/m2 , etoposide 1,200 mg/m2 , and ifosfamide 12 g/m2 . Results: Their median age was 19 years (range: 17–19 years). Two patients died of progressive disease. One patient was alive at last follow-up. The mean progression-free survival time was 23 months and mean survival time was 32 months. Toxicity of the treatment was manageable. Conclusion: HDCT and autologous bone marrow transplantation was successful in improving survival in patients with recurrent MB. The treatment was well tolerated and the toxicities were mild.
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PP-081 SEVERE RENAL FAILURE DUE TO HIGH DOSE METHOTREXATE IN ACUTE LYMPHOBLASTIC LEUKEMIA ASSOCIATED WITH PREDISPOSING FACTORS: CASE REPORT 1
2
3
1
1
1
M. Dagli , A. Basturk , L. Kutlucan , B. Copur , A. Kutlucan , F. Sahin . 1 Selcuk University, School of Medicine, Department of Hematology, Konya, Turkey; 2 Department of Hematology, Konya Training and Research Hospital, Konya, Turkey; 3 Department of Anesthesiology, Konya Training and Research Hospital, Konya, Turkey
dose chemotherapy and stem cell transplantation patients with delayed engraftment and persistent fever. PP-083 SECONDARY ALL IN MULTIPLE MYELOMA PATIENT WHO UNDERWENT HDC AND SCT S. Ozaydin, S. Ataergin, M. Ozturk, N. Karadurmus, G. Erdem, F. Arpaci. GATA Medical Oncology Clinic
Introduction: High dose methotrexate induced acute tubular damages is an important oncologic emergency in spite of preventive supportive treatment such as closely monitoring, leucovorin, hydration and alkalization. We report a case of severe renal insufficiency due to Hyper-CVAD in an acute lymphoblastic leukemia (ALL) with contributing factors such as diabetes and hypertension. Case: Hyper-CVAD was started to a 45 years old male ALL patient. He had diagnosis of diabetes mellitus and hypertension previously. After high-dose methotrexate infusion, preventive treatments such as adequate hydration and optimal dose folinic acid were given. Initially, the value of creatinine was 0.82 mg/dL. Despite preventive treatment, on the twelfth day of chemotherapy, creatinine value began to increase rapidly and acute renal failure occurred. Creatinine increased to 7.76 mg/dL and he became anuric. Dialysis and adequate supportive treatments were started immediately. He was monitored in the intensive care unit because of worsening of general condition. On the eighth day of acute renal failure the patient’s urine output has begun and septic shock improved during the course. The patient was discharged eventually. Discussion: High-dose methotrexate induced acute renal failure is a rare condition according to the other side effects of methotrexate. This rare side effect, in the presence of underlying predisposing factors may be more frequent and more severe. As in our case, even at normal creatinine values, while applying high-dose methotrexate we believe patients must be monitored closely for toxicity, adequate dose and duration of preventive treatment must be done and if possible dose adjustment would be appropriate especially in the presence of predisposing conditions to renal failure such as diabetes and hypertension.
Introduction: Secondary malignancies developing after chemotherapy, radiotherapy or stem cell transplantation (SCT) are mainly AML, MDS and carries severe complications and poor prognosis. ALL is a rare secondary malignancy after SCT for multiple myeloma cases. Case: A 58-year-old male with back pain was diagnosed solitary plasmocytoma on the T6 vertebra ten years ago. The evaluation confirmed multiple myeloma, IgG type and stage IIIA. Radiotherapy in to the involved area and 4 courses of VAD chemotherapy and 4 mg Zolendronic acid on a monthly schedule was given. After the completion of chemotherapy he underwent a double tandem autologous SCT of Melfalan 140 mg/m2 . After achieving a successful engraftment period, the patient continued on monthly Zoledronic acid treatment. However, 5 years ago, IgG levels progressively increased, erythrocyte sedimentation rate, CRP and serum β-2 macroglobulin levels increased as well. Thalidomide was initiated on a dose of 2×50 mg and his complaints regressed and laboratory test results were within normal ranges. The patient stopped the treatment after several years by himself. Six months ago he experienced dizziness, and syncope attacks. Laboratory examination showed abnormal results like WBC: 235,000/mm3 , hemoglobin 5.4 g/dl and Platelet: 13,000/mm3 . Peripheral blood smear showed diffuse blastic appearance. Bone marrow aspiration and biopsy confirmed ALL, which also was confirmed with flow cytometry showing excess expressions on CD10, CD19, CD34, HLA-DR and CD79a molecules. Therefore, ALL induction therapy and subsequently consolidation therapies were initiated. The patient is still in complete hematologic response and further High dose chemotherapy with allogeneic SCT is planned. Conclusion: According to the current literature, this is the second case of multiple myeloma who developed ALL as a secondary malignancy. Due to the rarity of these kinds of tumors, multinational data may provide better informational platform.
PP-082 DELAYED ENGRAFTMENT DUE TO CANDIDA NORVEGENSIS IN HDC AND SCT PATIENT
PP-084 THE OUTCOME OF HDC AND ASCT IN PATIENTS WITH RECURRENT MEDULLOBLASTOMA
S. Ozaydin, M. Ozturk, N. Karadurmus, G. Erdem, F. Arpaci. GATA Medical Oncology Clinic
S. Ozaydin, M. Ozturk, N. Karadurmus, G. Erdem, F. Arpaci. GATA Medical Oncology Clinic
Introduction: Invasive fungal infections are important causes of mortality in immunocompromised patients with hematologic malignancies. Candida infections cause about 40% of mortality and engraftment delay in patients with autologous/allogeneic stem cell transplantation. Case report: A 65-year-old lady with left axillary mass was diagnosed stage III, Diffuse Large B Cell NHL. Patient received 6 cycles of R-CHOP chemotherapy and complete remission was achieved after treatments. 3 months later, she complained about night sweats and weakness. Radiologic examination showed diffuse metastases in her liver. After 3 cycles of R-DHAP chemotherapy complete remission was achieved and high-dose chemotherapy (CEAM protocol) with autologous peripheral stem cell transplantation, in which a total of 1.9×106 /kg CD (34) cells were performed. Four days after stem cell reinfusion, fever and neutropenia developed and she received Meropenem monotherapy 1 gram by IV infusion every 8 hours. Within 48 hours fever increased and Teicoplanin was added to the treatments. Fever persisted and continue to rise and 72 hours after antibiotic treatments, Voricanazole was added to the combination. Even though wide spectrum antibiotics and antifungal agents were used fever did not reduced for five days. Candida Norvegensis was isolated from one of the peripheral blood samples and Liposomal Amphotericin B was used at 5 mg/kg per day. Due to persistent fever after Meronem, Teicoplanin and Liposomal Amphoterisin B treatment Teicoplanin was changed to Vancomycin. In addition to these drugs, caspofungin was added to the treatment. Leucocyte engraftment delayed and achieved at +21 day after stem cell reinfusion. Conclusion: This case showed that physicians must be aware of an unusual fungal infection like Candida Norvegensis and consider combination therapy if monotherapy with antifungal agents are not effective in high
Background: Medulloblastoma (MB) is the most common and very aggressive malignant embryonic brain tumor. Surgery, craniospinal irradiation and chemotherapy are the highest standard treatment used in MB. In adult patients, the five-year progression-free survival rate ranges from 45% to 75%. There is no established treatment with metastatic, unrespectable or recurrent MB. The outcome for patients with recurrent medulloblastoma is poor and most patients die usually within 12 to 15 months after retreatment with either chemotherapy or radiotherapy This study was designed to determine the efficiency and safety of high-dose chemotherapy (HDC) and stem cell transplantation (SCT) in patients with recurrent MB. Material and methods: This is a retrospective chart review of all patients with recurrent MB. Between 2004 and 2009, a total of 3 patients were treated for recurrent MB. All patients had received surgery, craniospinal irradiation and chemotherapy before relapse. Among the 3 patients, 2 complete responses and 1 partial response were observed in the followup periods. As the relapse occurred in complete response group during the follow-up period, all three patients were treated with high-dose chemotherapy followed by autologous bone marrow transplantation. The HDC consisted of carboplatin 1,200 mg/m2 , etoposide 1,200 mg/m2 , and ifosfamide 12 g/m2 . Results: Their median age was 19 years (range: 17–19 years). Two patients died of progressive disease. One patient was alive at last follow-up. The mean progression-free survival time was 23 months and mean survival time was 32 months. Toxicity of the treatment was manageable. Conclusion: HDCT and autologous bone marrow transplantation was successful in improving survival in patients with recurrent MB. The treatment was well tolerated and the toxicities were mild.