Antineoplastics

Abstract

Various toxicities: 2 case reports A case series described a 17-year-old girl and a 13-year-old girl; they developed invasive inonotus rhinosinusitis secondary to a fungal infection, neurotoxicity, peripheral neuropathy, pancreatitis, bacterial infection, hepatotoxicity or tuberculosis (TB) infection of the central nervous system (CNS) associated with Mycobacterium tuberculosis complex secondary to vaccine reactivation during chemotherapy with vincristine, dexamethasone, pegaspargase, mitoxantrone, methotrexate or blinatumomab for relapsed acute lymphoblastic leukaemia [ALL; not all routes and outcomes stated; dosages and durations of treatments to reactions onset not stated]. Patient 1: A 17-year-old girl, who had relapsed ALL, developed invasive inonotus rhinosinusitis during re-induction with dexamethasone, vincristine, pegasparagase, mitoxantrone and intrathecal methotrexate. Subsequent imaging showed fungal invasion of sinuses, cranial and facial bones, muscles and nerves. Initial treatment of the infection caused chemotherapy to be delayed 1 month, with a minimal residual disease (MRD) of 0.5%. However, MRD negative remission was achieved after completion of 1 cycle of blinatumomab. Her infection cleared after multiple surgical procedures, 8 cycles of blinonatumomab and treatment with amphotericin-B-liposomal and voriconazole, followed by posaconazole. Thereafter, she remained on negative MRD remission. Blinatumomab was held on two non-consecutive days due to the occurrence of neurotoxicity, apart from which, it was welltolerated. Patient 2: A 13-year-old girl, who had relapsed pre-B ALL, experienced vincristine-associated pancreatitis, peripheral neuropathy and bacterial infections. After transitioning to palliative chemotherapy, she presented to an outside hospital with fever and severe abdominal pain associated with hepatotoxicity due to AALL0433-like therapy, which consisted of vincristine. Subsequent imaging showed subfalcine and uncal herniation with prominent frontotemporal lobe oedema. An open biopsy showed positive results for Mycobacterium tuberculosis complex, which was indicative of vaccine reactivation. She received 12 cycles of blinatumomab, primarily as outpatient. She achieved negative MRD (0%) remission after 1 cycle of blinaotumumab. Her CNS TB infection was treated with isoniazid, pyrazinamide, ethambutol, rifampicin and levofloxacin. She returned to the outside hospital and remained in remission since then.