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Vincristine overdose: experience with 3 patients.
H V Kosmidis1, D O Bouhoutsou, M C Varvoutsi
1Department of Oncology, Children's Hospital, A. Kyriakou, Athens, Greece.
Pediatric Hematology and Oncology
|April 1, 1991
Summary
Accidental vincristine overdose in children with acute lymphoblastic leukemia was treated with exchange transfusion and folinic acid rescue. Survivors showed rapid vincristine clearance and recovery, while the non-survivor had persistent drug levels.
Area of Science:
- Pediatric Oncology
- Clinical Pharmacology
- Toxicology
Background:
- Vincristine is a critical chemotherapy agent for acute lymphoblastic leukemia (ALL).
- Accidental overdose of vincristine can lead to severe toxicity and potentially fatal outcomes.
- Management strategies for vincristine overdose are not well-established.
Observation:
- Three pediatric patients with ALL received an accidental vincristine overdose (7.5 mg/m2).
- Treatment involved double-volume exchange transfusion, prophylactic phenobarbital, and folinic acid rescue.
- Vincristine levels were monitored, showing rapid decline in survivors and stable levels in the patient who died.
Findings:
- Survivors experienced delayed toxicities including peripheral neuropathy, bone marrow suppression, gastrointestinal issues, and hypertension.
- Toxicities resolved over weeks to months in the surviving patients.
- The patient who succumbed developed severe liver and marrow toxicity and died within 9 days.
Implications:
- Exchange transfusion may be effective in reducing vincristine levels and improving outcomes after overdose.
- Prompt supportive care, including folinic acid rescue, is crucial for managing vincristine toxicity.
- This case highlights the importance of careful medication administration and preparedness for managing overdose events in pediatric oncology.