1
|
Scheurer ME, Zhou R, Gilbert MR, Bondy ML, Sulman EP, Yuan Y, Liu Y, Vera E, Wendland MM, Youssef EF, Stieber VW, Komaki RR, Flickinger JC, Kenyon LC, Robins HI, Hunter GK, Crocker IR, Chao ST, Pugh SL, Armstrong TS. Germline polymorphisms in MGMT associated with temozolomide-related myelotoxicity risk in patients with glioblastoma treated on NRG Oncology/RTOG 0825. Neurooncol Adv 2022; 4:vdac152. [PMID: 36299794 PMCID: PMC9587696 DOI: 10.1093/noajnl/vdac152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background We sought to identify clinical and genetic predictors of temozolomide-related myelotoxicity among patients receiving therapy for glioblastoma. Methods Patients (n = 591) receiving therapy on NRG Oncology/RTOG 0825 were included in the analysis. Cases were patients with severe myelotoxicity (grade 3 and higher leukopenia, neutropenia, and/or thrombocytopenia); controls were patients without such toxicity. A risk-prediction model was built and cross-validated by logistic regression using only clinical variables and extended using polymorphisms associated with myelotoxicity. Results 23% of patients developed myelotoxicity (n = 134). This toxicity was first reported during the concurrent phase of therapy for 56 patients; 30 stopped treatment due to toxicity. Among those who continued therapy (n = 26), 11 experienced myelotoxicity again. The final multivariable clinical factor model included treatment arm, gender, and anticonvulsant status and had low prediction accuracy (area under the curve [AUC] = 0.672). The final extended risk prediction model including four polymorphisms in MGMT had better prediction (AUC = 0.827). Receiving combination chemotherapy (OR, 1.82; 95% CI, 1.02-3.27) and being female (OR, 4.45; 95% CI, 2.45-8.08) significantly increased myelotoxicity risk. For each additional minor allele in the polymorphisms, the risk increased by 64% (OR, 1.64; 95% CI, 1.43-1.89). Conclusions Myelotoxicity during concurrent chemoradiation with temozolomide is an uncommon but serious event, often leading to treatment cessation. Successful prediction of toxicity may lead to more cost-effective individualized monitoring of at-risk subjects. The addition of genetic factors greatly enhanced our ability to predict toxicity among a group of similarly treated glioblastoma patients.
Collapse
Affiliation(s)
- Michael E Scheurer
- Baylor College of Medicine, Departments of Pediatrics and Medicine, Houston, Texas, USA
| | - Renke Zhou
- Baylor College of Medicine, Departments of Pediatrics and Medicine, Houston, Texas, USA
| | - Mark R Gilbert
- National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Melissa L Bondy
- Baylor College of Medicine, Departments of Pediatrics and Medicine, Houston, Texas, USA
| | - Erik P Sulman
- M D Anderson Cancer Center, Brain and Spine Center, Houston, TX, USA
- Laura and Isaac Perlmutter Cancer Center at NYU Langone, New York, NY, USA
| | - Ying Yuan
- M D Anderson Cancer Center, Brain and Spine Center, Houston, TX, USA
| | - Yanhong Liu
- Baylor College of Medicine, Departments of Pediatrics and Medicine, Houston, Texas, USA
| | - Elizabeth Vera
- National Institutes of Health Clinical Center, Bethesda, MD, USA
- M D Anderson Cancer Center, Brain and Spine Center, Houston, TX, USA
| | - Merideth M Wendland
- National Cancer Institute, Bethesda, MD, USA
- Texas Oncology Cancer Center Sugar Land, Sugar Land, TX, USA
| | | | | | - Ritsuko R Komaki
- M D Anderson Cancer Center, Brain and Spine Center, Houston, TX, USA
| | | | | | - H Ian Robins
- University of Wisconsin Hospital, Madison, WI, USA
| | | | - Ian R Crocker
- Emory University, Winship Cancer Institute, Atlanta, GA, USA
| | | | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA
| | | |
Collapse
|
2
|
Park AK, Waheed A, Forst DA, Al-Samkari H. Characterization and Prognosis of Temozolomide-Induced Aplastic Anemia in Patients with Central Nervous System Malignancies. Neuro Oncol 2021; 24:964-973. [PMID: 34647594 DOI: 10.1093/neuonc/noab240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Temozolomide-induced aplastic anemia (TIAA) is a rare but highly challenging complication of temozolomide (TMZ) therapy. Evidence describing prognosis, clinical characteristics, and treatment of this entity is very limited. METHODS We performed a multicenter, 22-year observational cohort study of patients with central nervous system (CNS) malignancies treated with temozolomide who developed TIAA, retrospectively analyzing prognosis, complications, and recovery. TIAA was defined using adapted evidence-based severe aplastic anemia criteria incorporating profound cytopenias and a minimum duration (4 weeks) without hematologic recovery. RESULTS Of 3,821 patients with CNS malignancies receiving TMZ, 34 patients (0.89%) met criteria for TIAA. Onset was rapid, with 29 patients (85.3%) developing TIAA before completing a second TMZ cycle. 23 patients (67.6%) ultimately achieved a hematologic recovery. Patients without recovery were more likely to develop febrile neutropenia (72.7% vs. 30.4%, P=0.03), infectious complications (45.5% vs. 8.7%, P=0.02), require hospitalization (81.8% vs. 43.5%, P=0.04), and die (100.0% vs. 60.9%, P=0.02). Median overall survival from TIAA diagnosis was 752 days in patients achieving a partial hematologic recovery versus 28 days in those who did not (P<0.0001). 29 patients (85.3%) received one or more hematopoietic growth factors; hematologic recovery rates were higher in patients receiving thrombopoietin receptor agonists (81.8% vs. 60.9%) but were not higher in patients receiving granulocyte colony stimulating factors. CONCLUSIONS TIAA occurs in <1% of patients receiving TMZ for CNS malignancies, but is highly morbid when it occurs and frequently fatal in the one-third of patients not achieving hematologic recovery. Thrombopoietin receptor agonists may improve the likelihood of a hematologic recovery.
Collapse
Affiliation(s)
- Albert K Park
- Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Anem Waheed
- Harvard Medical School, Boston, MA.,Division of Hematology Oncology, Massachusetts General Hospital, Boston, MA
| | - Deborah A Forst
- Harvard Medical School, Boston, MA.,Division of Neuro-Oncology, Massachusetts General Hospital, Boston, MA
| | - Hanny Al-Samkari
- Harvard Medical School, Boston, MA.,Division of Hematology Oncology, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
3
|
Ata F, Akkam Veettil SF, Gaber M, Omar NE, Madani A, Mah Afifi H, Aldardouri MM, Amer A, Kohla S, Zar Gul AR. Fatal temozolomide induced aplastic anemia in a female with Glioblastoma multiforme : A case report and literature review. Clin Case Rep 2021; 9:1641-1646. [PMID: 33768906 PMCID: PMC7981661 DOI: 10.1002/ccr3.3860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/28/2020] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
When seeing patients on Temozolomide with pancytopenia, aplastic anemia secondary to the drug should be considered early in the differentials to avoid permanent hematological suppression.
Collapse
Affiliation(s)
- Fateen Ata
- Department of Internal Medicine Hamad General Hospital Hamad Medical Corporation Doha Qatar
| | | | - Mohammed Gaber
- Department of Oncology National Center for Cancer Care & Research Hamad Medical Corporation Doha Qatar
| | - Nabil E Omar
- Pharmacy Department National Center for Cancer Care & Research Hamad Medical Corporation Doha Qatar
| | - Ammar Madani
- Department of Oncology National Center for Cancer Care & Research Hamad Medical Corporation Doha Qatar
| | - Hebatalla Mah Afifi
- Pharmacy Department National Center for Cancer Care & Research Hamad Medical Corporation Doha Qatar
| | - Meeloud M Aldardouri
- Department of Oncology National Center for Cancer Care & Research Hamad Medical Corporation Doha Qatar
| | - Aliaa Amer
- Hematopathology Division, Department of Laboratory Medicine and Pathology Hamad Medical Corporation Doha Qatar
| | - Samah Kohla
- Hematopathology Division, Department of Laboratory Medicine and Pathology Hamad Medical Corporation Doha Qatar
| | - Abdul Rehman Zar Gul
- Department of Oncology National Center for Cancer Care & Research Hamad Medical Corporation Doha Qatar
| |
Collapse
|
4
|
Ata F, Akkam Veettil SF, Gaber M, Omar NE, Madani A, Mah. Afifi H, Aldardouri MM, Amer A, Kohla S, Zar Gul AR. Fatal temozolomide induced aplastic anemia in a female with Glioblastoma multiforme : A case report and literature review. Clin Case Rep 2021; 9:1641-1646. [DOI: https:/doi.org/10.1002/ccr3.3860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/11/2021] [Indexed: 08/30/2023] Open
Affiliation(s)
- Fateen Ata
- Department of Internal Medicine Hamad General HospitalHamad Medical Corporation Doha Qatar
| | | | - Mohammed Gaber
- Department of Oncology National Center for Cancer Care & ResearchHamad Medical Corporation Doha Qatar
| | - Nabil E. Omar
- Pharmacy Department National Center for Cancer Care & ResearchHamad Medical Corporation Doha Qatar
| | - Ammar Madani
- Department of Oncology National Center for Cancer Care & ResearchHamad Medical Corporation Doha Qatar
| | - Hebatalla Mah. Afifi
- Pharmacy Department National Center for Cancer Care & ResearchHamad Medical Corporation Doha Qatar
| | - Meeloud M. Aldardouri
- Department of Oncology National Center for Cancer Care & ResearchHamad Medical Corporation Doha Qatar
| | - Aliaa Amer
- Hematopathology Division, Department of Laboratory Medicine and Pathology Hamad Medical Corporation Doha Qatar
| | - Samah Kohla
- Hematopathology Division, Department of Laboratory Medicine and Pathology Hamad Medical Corporation Doha Qatar
| | - Abdul Rehman Zar Gul
- Department of Oncology National Center for Cancer Care & ResearchHamad Medical Corporation Doha Qatar
| |
Collapse
|
5
|
Khaddour K, Harrison N, Govindan A, Campian JL. Development of Aplastic Anemia during Treatment of Anaplastic Astrocytoma with Temozolomide. Case Rep Oncol 2020; 13:1244-1251. [PMID: 33250738 PMCID: PMC7670352 DOI: 10.1159/000509744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 01/10/2023] Open
Abstract
Temozolomide (TMZ) is an oral alkylating agent that is considered the standard therapy in primary intracranial malignancies. The medication is well tolerated with a most common side effect of bone marrow suppression that is encountered in a small proportion of patients, often reversible with medication discontinuation and supportive treatment. Rarely, aplastic anemia can develop during treatment with TMZ. Here, we present a case of a patient who developed aplastic anemia following treatment with TMZ. We offer a review of the existing literature to have a better understanding of the causative effect and to examine the characteristics and outcomes when aplastic anemia develops during treatment with TMZ.
Collapse
Affiliation(s)
- Karam Khaddour
- Division of Oncology, Washington University at Saint Louis, Saint Louis, Missouri, USA
| | - Nigel Harrison
- Division of Neurology, Washington University at Saint Louis, Saint Louis, Missouri, USA
| | - Ashwin Govindan
- Division of Oncology, Washington University at Saint Louis, Saint Louis, Missouri, USA
| | - Jian L Campian
- Division of Oncology, Washington University at Saint Louis, Saint Louis, Missouri, USA
| |
Collapse
|
6
|
Gilbar PJ, Pokharel K, Mangos HM. Temozolomide-induced aplastic anaemia: Case report and review of the literature. J Oncol Pharm Pract 2020; 27:1275-1280. [PMID: 33086908 DOI: 10.1177/1078155220967087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Temozolomide (TMZ) is an oral alkylating agent principally indicated for neurological malignancies including glioblastoma (GBM) and astrocytoma. Most common side effects are mild to moderate, and include fatigue, nausea, vomiting, thrombocytopenia and neutropenia. Severe or prolonged myelosuppression, causing delayed treatment or discontinuation, is uncommon. Major haematological adverse effects such as myelodysplastic syndrome or aplastic anaemia (AA) have rarely been reported. CASE REPORT We report a 68-year old female with GBM treated at a tertiary hospital with short-course radiotherapy and concurrent temozolomide following craniotomy. On treatment completion she was transferred to our hospital for rehabilitation. She was thrombocytopenic on admission. Platelets continued falling with significant pancytopenia developing over the next two weeks. Blood parameters and a markedly hypocellular bone marrow confirmed the diagnosis of very severe AA, probably due to TMZ. MANAGEMENT AND OUTCOME Treatment consisted of repeated platelet transfusions, intravenous antibiotics, antiviral and antifungal prophylaxis, and G-CSF 300 mcg daily. Platelet and neutrophil counts had returned to normal at 38 days following the completion of TMZ treatment. DISCUSSION Whilst most cases of AA are idiopathic, a careful drug, occupational exposure and family history should be obtained, as acquired AA may result from viruses, chemical exposure, radiation and medications. Temozolomide-induced AA is well documented, though only 12 cases have been described in detail. Other potential causes were eliminated in our patient. Physicians should be aware of this rare and potentially fatal toxicity when prescribing. Frequent blood tests should be performed, during and following TMZ treatment, to enable early detection.
Collapse
Affiliation(s)
- Peter J Gilbar
- Cancer Care Services, Toowoomba Hospital, Toowoomba, Australia.,Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Australia
| | - Khageshwor Pokharel
- Cancer Care Services, Toowoomba Hospital, Toowoomba, Australia.,Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Australia
| | - Hilda M Mangos
- Cancer Care Services, Toowoomba Hospital, Toowoomba, Australia
| |
Collapse
|
7
|
Batalini F, Kaufmann MR, Aleixo GF, Drews R. Temozolomide-induced aplastic anaemia and incidental low-grade B-cell non-Hodgkin lymphoma in a geriatric patient with glioblastoma multiforme. BMJ Case Rep 2019; 12:e228803. [PMID: 31256047 PMCID: PMC6605928 DOI: 10.1136/bcr-2018-228803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2019] [Indexed: 11/03/2022] Open
Abstract
Glioblastoma multiforme is an astrocyte-derived tumour representing the most aggressive primary brain malignancy. The median overall survival is 10-12 months, but it drops to 3-8.5 months for the cohort with more than 65 years old, which account to half of all patients. Initial management in this patient population aims to balance overall patient survival and quality of life with the inherent risks of treatment intervention, which include maximal safe tumour resection, radiation and temozolomide (TMZ) chemotherapy. This is accomplished through risk stratification as a function of patient age, functional status, comorbidities, tumour location and methylguanine methyltransferase promoter methylation status. We describe the care of a patient with prolonged febrile neutropaenia, with a rare but fatal complication from TMZ-induced idiosyncratic reaction, leading to aplastic anaemia and a provoking diagnosis of low-grade B-cell non-Hodgkin's lymphoma.
Collapse
Affiliation(s)
- Felipe Batalini
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Matthew R Kaufmann
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Gabriel Francisco Aleixo
- Department of Medicine, Universidade do Oeste Paulista Faculdade de Medicina, Presidente Prudente, São Paulo, Brazil
| | - Reed Drews
- Department of Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Karremann M, Krämer N, Hoffmann M, Wiese M, Beilken A, Corbacioglu S, Dilloo D, Driever PH, Scheurlen W, Kulozik A, Gielen GH, von Bueren AO, Dürken M, Kramm CM. Haematological malignancies following temozolomide treatment for paediatric high-grade glioma. Eur J Cancer 2017; 81:1-8. [PMID: 28586748 DOI: 10.1016/j.ejca.2017.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 04/25/2017] [Accepted: 04/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Temozolomide (TMZ) is widely used in high-grade glioma (HGG). There is a major concern of treatment-induced secondary haematological malignancies (SHMs). Due to the poor overall survival of HGG patients, the true incidence is yet elusive. Thus, the aim of this study was to determine the risk of SHMs following TMZ in paediatric HGG. METHODS We analysed 487 patients from the HIT-HGG database of the German-speaking Society of Pediatric Oncology and Hematology with follow up beyond 1 year. RESULTS The incidence of SHM was 7.7 ± 3.2% at 10 years. No SHM occurred in 194 patients after first-line TMZ therapy, but four out of 131 patients treated with TMZ for relapse following first-line multiagent chemotherapy experienced SHM (20% at 10 years; p = 0.041). SHMs occurred in two out of 162 patients who underwent multiagent chemotherapy without TMZ (4.1% at 10 years). Gender, patient age and acute haematological toxicity during treatment did not affect the incidence of SHMs. CONCLUSION Data of our cohort do not indicate an increased risk of SHM following TMZ treatment when compared to previous chemotherapy regimen. However, if TMZ is administered as a second-line treatment following conventional chemotherapy regimen, the risk might be disproportionately increasing.
Collapse
Affiliation(s)
- Michael Karremann
- Department of Pediatric and Adolescent Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Nadja Krämer
- Department of Pediatric and Adolescent Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marion Hoffmann
- Division of Pediatric Hematology and Oncology, Department of Child and Adolescent Health, University Medical Center Göttingen, Göttingen, Germany
| | - Maria Wiese
- Division of Pediatric Hematology and Oncology, Department of Child and Adolescent Health, University Medical Center Göttingen, Göttingen, Germany
| | - Andreas Beilken
- Department of Pediatric Hematology and Oncology, Medical School Hannover, Hannover, Germany
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Children's Hospital Regensburg, Regensburg, Germany
| | - Dagmar Dilloo
- Department of Pediatric Hematology and Oncology, Center for Child and Adolescent Medicine, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfram Scheurlen
- Cnopf'sche Kinderklinik, Nürnberg Children's Hospital, Nürnberg, Germany
| | - Andreas Kulozik
- Department of Pediatric Hematology, Oncology and Immunology, Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Gerrit H Gielen
- Department of Neuropathology, University Hospital Bonn, 53105 Bonn, Germany
| | - André O von Bueren
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Matthias Dürken
- Department of Pediatric and Adolescent Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christof M Kramm
- Division of Pediatric Hematology and Oncology, Department of Child and Adolescent Health, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
9
|
Vandraas K, Tjønnfjord GE, Johannesen TB, Brandal P. Persistent bone marrow depression following short-term treatment with temozolomide. BMJ Case Rep 2016; 2016:bcr-2016-215797. [PMID: 27130558 DOI: 10.1136/bcr-2016-215797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Temozolomide (TMZ) is, in combination with radiotherapy (RT), the treatment of choice for glioblastoma multiforme. Although generally well tolerated, haematological side effects are observed in approximately 1-10% of patients receiving TMZ. We report a case of a patient who developed severe bone marrow failure (BMF) after only 3 weeks of concomitant TMZ. The BMF was grave with no signs of improvement for 12 months, resulting in more than 100 transfusions of blood cells.
Collapse
|
10
|
Melero-Jerez C, Ortega MC, Moliné-Velázquez V, Clemente D. Myeloid derived suppressor cells in inflammatory conditions of the central nervous system. Biochim Biophys Acta Mol Basis Dis 2015; 1862:368-80. [PMID: 26527182 DOI: 10.1016/j.bbadis.2015.10.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 10/16/2015] [Accepted: 10/19/2015] [Indexed: 12/11/2022]
Abstract
The knowledge of the immune system elements and their relationship with other tissues, organs and systems are key approximations for the resolution of many immune-related disorders. The control of the immune response and/or its modulation from the pro-inflammatory to the anti-inflammatory response is being deeply studied in the field. In the last years, the study of myeloid-derived suppressor cells (MDSCs), a group of immature myeloid cells with a high suppressive activity on T cells has been extensively addressed in cancer. In contrast, their role in neuroimmune diseases is far from being totally understood. In this review, we will summarize data about MDSCs coming from the study of neuroinflammatory diseases in general and their potential role in multiple sclerosis, in order to introduce the putative use of this extraordinary promising cell type for future cell-based therapies. This article is part of a Special Issue entitled: Neuro Inflammation edited by Helga E. de Vries and Markus Schwaninger.
Collapse
Affiliation(s)
- Carolina Melero-Jerez
- Grupo de Neurobiología del Desarrollo-GNDe, Hospital Nacional de Parapléjicos, Finca "La Peraleda" s/n, E-45071 Toledo, Spain
| | - María Cristina Ortega
- Grupo de Neurobiología del Desarrollo-GNDe, Hospital Nacional de Parapléjicos, Finca "La Peraleda" s/n, E-45071 Toledo, Spain; Centro de Biología Molecular Severo Ochoa. Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Verónica Moliné-Velázquez
- Animal Experimental Unit, Scientific Instrumentation Center (CIC), Campus de la Cartuja, Universidad de Granada, Granada, Spain
| | - Diego Clemente
- Grupo de Neurobiología del Desarrollo-GNDe, Hospital Nacional de Parapléjicos, Finca "La Peraleda" s/n, E-45071 Toledo, Spain.
| |
Collapse
|
11
|
Scaringi C, De Sanctis V, Minniti G, Enrici RM. Temozolomide-related hematologic toxicity. ACTA ACUST UNITED AC 2013; 36:444-9. [PMID: 23921765 DOI: 10.1159/000353752] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Temozolomide (TMZ) is an oral alkylating agent used for the treatment of recurrent or newly diagnosed malignant gliomas with significant survival benefit. TMZ is generally well tolerated and safe. The most common side effects are mild to moderate, and are represented by fatigue, nausea, vomiting, thrombocytopenia, and neutropenia. However severe hematologic adverse events (HAEs), including myelodysplastic syndrome and aplastic anemia, have also been reported. In this review we present an overview of the available literature of HAEs after exposure to TMZ.
Collapse
Affiliation(s)
- Claudia Scaringi
- Department of Radiation Oncology, St Andrea Hospital, University Sapienza, Rome, Italy
| | | | | | | |
Collapse
|
12
|
Temozolomide-related idiosyncratic and other uncommon toxicities: a systematic review. Anticancer Drugs 2013; 23:1099-106. [PMID: 22850321 DOI: 10.1097/cad.0b013e328356f5b0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Temozolomide (TMZ)-related idiosyncratic and other uncommon toxicities have been reported. To better characterize these toxicities and to identify any associated risk factors, we performed a systematic review. We searched the PubMed database, limited to the English language, published between 1999 and December 2011. We selected only those articles in which TMZ was temporally related and was the sole or main contributing chemotherapeutic drug to idiosyncratic drug reactions (IDRs) and other uncommon toxicities. Hematological IDRs are biopsy-proven aplastic anemia or grade V toxicity or grade IV toxicity with slow and incomplete hematological recovery. Seventy-three cases were identified, including 21 hematological IDRs, 31 nonhematological IDRs and uncommon infections, and 21 second primary cancers. With a caveat of publication and reporting bias, the following observations could be made. The hematological IDRs predominantly occurred in female patients (exact binomial two-tailed, P=0.0041) and most patients were receiving TMZ concomitantly with radiotherapy for glioma. The median duration of exposure to TMZ was 30 days and the median cumulative TMZ exposure was 2250 mg/m (range, 500-6900 mg/m). The sex predilection was not evident in nonhematological IDRs and other uncommon toxicities. TMZ-induced pneumonitis and cholestatic hepatitis are emerging as a nonhematological hypersensitive reaction and IDR, respectively. For TMZ-related myelodysplasia or leukemia, the cumulative dose of TMZ ranged from 1400 to 30 000 mg/m. The cumulative dose of TMZ was lower and latency was shorter with a previous exposure to other leukemogenic drugs, suggesting that TMZ may have augmented the leukemogenic potential of other drugs. Early appearance of profound myelosuppression during the course of TMZ and concurrent radiotherapy could be a hematological IDR, which warrants prompt investigations to exclude aplastic anemia. Myelodysplasia or leukemia developed after a median TMZ exposure of 15 g/m.
Collapse
|
13
|
Akyüz C, Demir HA, Varan A, Yalçin B, Kutluk T, Büyükpamukçu M. Temozolomide in relapsed pediatric brain tumors: 14 cases from a single center. Childs Nerv Syst 2012; 28:111-5. [PMID: 21866330 DOI: 10.1007/s00381-011-1561-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 08/10/2011] [Indexed: 11/25/2022]
Abstract
AIM Temozolomide is an active drug against gliomas in adults. It also has some promising effects in pediatric patients with brain tumors. We have conducted a retrospective study to investigate the effectiveness of temozolomide in patients with relapsed brain tumors. PATIENTS AND METHODS The files of 14 children treated at our hospital between 2005 and 2010 with the diagnoses of relapsed brain tumors were reviewed for pathological characteristics, treatment results, and outcomes. RESULTS The median age at relapse was 8 years (range, 1.08-23; F/M, 5/9). Diagnoses included medulloblastoma (n = 5), atypical teratoid rhabdoid tumor (n = 2), ependymoma (n = 2), glioneuronal tumor (n = 1), malignant neoplasm (n = 1), pontine glioma (n = 1), astrocytoma grade III (n = 1), and glioblastoma multiforme (n = 1). All patients except the one with pontine glioma had undergone surgical resection, and all had prior adjuvant chemotherapy. Twelve out of 14 patients had received radiotherapy. The median number of temozolomide courses was 5.0 (range, 1-24). Objective response rate in our patients was 35.7% (three complete responses, one partial response, and one minor response). Stable disease achieved in 14.3% of patients and 50% had progressive disease. Median survival time was 8 months (range, 1-55). At the end of the study, three patients were alive. Hematological toxicity was seen in 30.8% of all courses. CONCLUSIONS Relapsed brain tumors in childhood have an unfavorable prognosis. These data suggest that temozolomide might be an active agent against recurrent medulloblastoma. Although overall objective response rate was low, further multicentric studies with temozolomide may be warranted in children with recurrent brain tumors.
Collapse
Affiliation(s)
- Canan Akyüz
- Institute of Oncology, Department of Pediatric Oncology, Hacettepe University, 06100 Ankara, Turkey
| | | | | | | | | | | |
Collapse
|
14
|
Oh J, Kutas GJ, Davey P, Morrison M, Perry JR. Aplastic anemia with concurrent temozolomide treatment in a patient with glioblastoma multiforme. ACTA ACUST UNITED AC 2011; 17:124-6. [PMID: 20697524 DOI: 10.3747/co.v17i4.526] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Temozolomide (TMZ) is an oral alkylating agent used during concurrent and adjuvant chemotherapy for newly diagnosed glioblastoma multiforme. Temozolomide is generally well tolerated and improves survival; however, severe adverse events have occasionally been reported. Here, we report the case of a patient who developed aplastic anemia with related complications in the setting of concurrent TMZ treatment with radiotherapy. This case illustrates that aplastic anemia is a rare side effect of TMZ that can occur relatively early in the course of concurrent chemotherapy, and underscores the importance of clinician awareness of this potentially devastating side effect.
Collapse
Affiliation(s)
- J Oh
- Division of Neurology, Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON.
| | | | | | | | | |
Collapse
|