Massive vincristine overdose: failure of leucovorin to reduce toxicity

The case history of a 24-year-old male with the nodular sclerosing form of Hodgkin's disease (stage IIE) who accidentally received an overdose of vincristine (25 mg, 0.39 mg/kg) is reported. To date, ten patients given a vincristine overdose have been reported. Two of those patients were treated with leucovorin. One patient died after 68 hours. In the second patient, the time to onset and the duration of symptoms were shortened. In an attempt to reduce the duration of toxic effects in our patient, leucovorin was administered 24 hours after the overdose. In agreement with the earlier observation, the time to onset of symptoms was short, but in contrast we did not find a more rapid recovery from the serious side effects. Although the patient might have died without leucovorin administration, we believe its beneficial effect remains to be established.