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Deferoxamine (Desferal)-induced ocular toxicity
C Kaplinsky1, B Stark, Y Goshen
1Department of Pediatric Hematology-Oncology, Beilinson Medical Center, Petah Tikva, Israel.
Pediatric Hematology and Oncology
|January 1, 1988
Summary
High-dose deferoxamine, an iron chelator, combined with chemotherapy for relapsed leukemia caused vision loss and pancytopenia. This case highlights potential deferoxamine toxicity in pediatric patients undergoing intensive treatment.
Area of Science:
- Pediatric Oncology
- Hematology
- Ophthalmology
Background:
- Juvenile chronic myeloid leukemia (JCML) relapse post-allogeneic bone marrow transplantation (BMT) presents a therapeutic challenge.
- Conventional chemotherapy resistance necessitates exploring alternative treatment strategies.
Observation:
- A pediatric patient with refractory JCML received high-dose deferoxamine (iron chelator) and low-dose ARA-c.
- Remarkable reduction in white blood cell (WBC) count and fetal hemoglobin (HbF) was observed.
- Acute visual loss occurred three days after deferoxamine treatment, confirmed by electroretinogram (ERG) and visual evoked response (VER).
Findings:
- Ocular toxicity, characterized by metabolic damage on ERG and VER, was attributed to deferoxamine.
- Severe pancytopenia developed post-treatment.
- The patient succumbed to Klebsiella septic shock.
Implications:
- Deferoxamine, while effective in reducing leukemia markers, carries a risk of significant ocular toxicity.
- This case underscores the importance of monitoring visual function during deferoxamine therapy in pediatric oncology.
- Understanding deferoxamine's toxicological mechanisms is crucial for optimizing its use in complex cases.