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Severe hypertensive reactions to teniposide (VM-26) in infants with congenital leukemia
H Shimizu1, L S Frankel, S J Culbert
1Department of Pediatrics, University of Texas M.D. Anderson Hospital and Tumor Institute at Houston 77030.
Insights
Infants with congenital leukemia experienced severe high blood pressure from teniposide (VM-26). This toxicity, potentially age-specific, necessitates careful blood pressure monitoring in young patients undergoing this chemotherapy.
Area of Science:
- Pediatric Oncology
- Pharmacology
- Hematology
Background:
- Congenital leukemia presents unique challenges in pediatric treatment.
- Teniposide (VM-26) is a chemotherapeutic agent used in treating certain leukemias.
- Understanding drug toxicities in infants is crucial for safe and effective treatment.
Observation:
- Two infant cases with congenital leukemia exhibited severe, refractory hypertensive reactions to teniposide.
- Hypertension, defined as systolic blood pressure >200 mm Hg, occurred after the second dose of teniposide.
- These reactions were observed in patients on a 5 mg/kg twice-weekly dosing schedule.
Findings:
- The hypertensive reactions were severe and difficult to manage (refractory).
- In one case, hypertension combined with myelosuppression led to a fatal outcome.
- The exact mechanism of teniposide-induced hypertension in infants remains unknown.
Implications:
- The toxicity may be specific to the very young age of the patients.
- Close monitoring of vital signs, particularly blood pressure, is mandatory for infants receiving teniposide.
- This highlights the need for further research into age-specific chemotherapy side effects and management strategies.
Abstract:
Two cases of infants with congenital leukemia who had severe, refractory hypertensive reactions to teniposide (VM-26) are described. Patients on a 5 mg/kg twice weekly schedule of teniposide had hypertensive reactions in which their systolic blood pressure was greater than 200 mm Hg after the second dose of teniposide. Hypertension combined with myelosuppression resulted in the patient's death in one case. Although the exact mechanism of this unusual toxicity of teniposide remains unknown, it might be an age-specific problem, considering the very young age of our patients. Meticulous monitoring of vital signs, including blood pressure, is mandatory in leukemic infants receiving teniposide.