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Related Experiment Videos

Massive pleural effusion attributed to high-dose cyclophosphamide during conditioning for BMT

N Schaap1, R Raymakers, A Schattenberg

  • 1Division of Hematology, University Hospital Nijmegen, The Netherlands.

Bone Marrow Transplantation
|July 1, 1996
PubMed
Summary

A patient experienced severe respiratory distress and cardiac issues shortly after high-dose cyclophosphamide (CY) treatment for leukemia. This rare, rapid-onset reaction resolved quickly with pleural drainage, allowing transplantation to proceed.

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Area of Science:

  • Hematology
  • Oncology
  • Pharmacology

Background:

  • Allogeneic bone marrow transplantation is a critical treatment for chronic myelogenous leukemia.
  • High-dose cyclophosphamide (CY) is often used in conditioning regimens prior to transplantation.
  • Mesna rescue is employed to mitigate urotoxicity associated with chemotherapy agents like CY.

Observation:

  • A 37-year-old male developed massive pleural effusion, respiratory failure, and electromechanical dissociation within 24 hours of receiving the second dose of 4200 mg cyclophosphamide.
  • The patient required immediate resuscitation and bilateral pleural drainage.
  • Recovery from the acute reaction occurred within 1 day, enabling subsequent treatment continuation.

Findings:

  • The observed reaction, characterized by rapid-onset pleural effusion and cardiorespiratory compromise, is a previously unreported idiosyncratic event.

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  • The reaction is hypothesized to be linked to high-dose cyclophosphamide administration in conjunction with mesna rescue.
  • No other causative factors were identified for this severe adverse event.

    • Implications:

    • This case highlights a potentially life-threatening, idiosyncratic reaction to high-dose cyclophosphamide and mesna rescue in the context of bone marrow transplantation.
    • Clinicians should be vigilant for rapid-onset pleural effusions and cardiorespiratory distress in patients receiving similar conditioning regimens.
    • Further investigation may be warranted to elucidate the precise mechanism of this rare adverse event and inform preventative strategies.