1: Rinsho Ketsueki 2000 Nov;41(11):1231-7

[Severe hemolysis and SIADH-like symptoms induced by vincristine in an ALL patient with liver cirrhosis]

[Article in Japanese]

Nishihori Y, Yamauchi N, Kuribayashi K, Sato Y, Morii K, Hirayama Y, Sakamaki S, Honma H, Suzuki N, Kudo T, Niitsu Y.

Department of Internal Medicine (Section 4), Sapporo Medical University School of Medicine.

An 11-year-old boy was diagnosed as having acute lymphoblastic leukemia (ALL, L1) in 1987 and underwent treatment with an ALL high-risk protocol (prednisolone, vincristine (VCR), daunorubicin, 1-asparaginase), which resulted in complete remission. In 1990 he developed chronic hepatitis C and received interferon therapy. In December 1994, ALL recurred, and the patient was treated with VCR. He subsequently developed severe hemolysis (Hb 12.5 g/dl-->6.8 g/dl) with increases of indirect bilirubin, AST, and LDH. Furthermore, symptoms resembling a syndrome of inappropriate secretion of ADH (SIADH) and DIC developed. Upon incubation of the patient's red blood cells with VCR in vitro, extreme deformity of the cells was observed. These findings suggested that splenomegaly, due to liver cirrhosis which had developed rapidly from chronic hepatitis C while the patient was in an immunosuppressed state induced by anticancer drugs, had trapped the deformed red blood cells and resulted in severe hemolysis. The patient died on the 165th day after admission due to liver failure.

PMID: 11193445 [PubMed - indexed for MEDLINE]

1: Gan To Kagaku Ryoho 2000 Jan;27(1):99-102

[Syndrome of inappropriate secretion of antidiuretic hormone in a patient with myeloid antigen positive acute lymphoblastic leukemia after systemic chemotherapy including vincristine]

[Article in Japanese]

Yoshida M, Ogawa K, Sakamoto H, Motomura S, Ishigatsubo Y.

Dept. of Collagen Disease and Hematology, Fujisawa City Hospital.

We report a case of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) after the patient had received several anti-cancer drugs, including vincristine (VCR), in a patient with myeloid antigen positive acute lymphoblastic leukemia (My(+)-ALL). A 53-year-old woman presented at the hospital complaining of high-grade fever and general lassitude. Further examination revealed that she had My(+)-ALL. On admission, she was treated with anti-cancer drugs, including VCR. On day 24, after the first administration of VCR, a conscious disturbance suddenly occurred and she was diagnosed with SIADH. A plain head CT scan showed a low density lesion through the gray matter to the white matter in the bilateral occipital lobe, as well as diffuse swelling of the cerebrum. This was not seen on the follow up CT scan, and we concluded that it had been a transient abnormal finding due to SIADH. She achieved complete remission after induction chemotherapy and 3 added courses of consolidation chemotherapy. VCR was also administered 4 times in the second consolidation chemotherapy, but hyponatremia did not occur. This case suggests that a head CT scan is a useful procedure for the diagnosis and monitoring of SIADH, and that VCR may still be used in a patient who has suffered from VCR-induced SIADH.

PMID: 10660739 [PubMed - indexed for MEDLINE]

1: Padiatr Padol 1985;20(2):117-26

[Electrolyte changes in acute leukemia in childhood]

[Article in German]

Gadner H, Martins da Cunha AC.

Electrolyte imbalance in leukemia can be due to either organ infiltration and cell death or to a side effect of cytostatic drugs. From the wide variety of these disturbances seen in acute leukemias in childhood, the excess of potassium is most dangerous. Further electrolyte changes, which are however less evident, are hyperphosphataemia, hyperphosphaturia, and hypocalcaemia. The destruction of a large amount of cells during aggressive induction therapy can boost the electrolyte imbalance and therefore lead to renal failure. Such situations are demonstrated in two cases. Following Vincristine and Cyclophosphamide administration, electrolyte changes such as acute or prolonged decrease of sodium in the serum and urinary loss of sodium are seen frequently. Based on the data from 20 patients with acute lymphoblastic leukemias we describe the dynamics of this process. These changes are probably caused by the syndrome of inadequate ADH-secretion. The clinical importance of these findings are discussed and procedures for improving therapy are set out.

PMID: 3857551 [PubMed - indexed for MEDLINE]

1: Rinsho Ketsueki 1986 Oct;27(10):1916-21

[Successful vindesine treatment in the patient with blastic crisis of CML complicated with syndrome of inappropriate secretion of ADH secondary to vincristine]

[Article in Japanese]

Nishinarita S, Sasaki I, Hiranuma M, Sugai Y, Yoshizawa T, Sawada S, Amaki I.

PMID: 3469429 [PubMed - indexed for MEDLINE]

1: An Esp Pediatr 1988 Oct;29 Suppl 34:155-6

[Inappropriate ADH syndrome and other toxic effects in the course of childhood ALL treated with vincristine]

[Article in Spanish]

Indiano JM, Gonzalez A, Oria de Rueda O, Sanchez E.

Universidad del Pais Vasco, Departamento de Pediatria, Hospital de Basurto, Bilbao.

PMID: 3214029 [PubMed - indexed for MEDLINE]

1: Blood 1975 Mar;45(3):315-20

Syndrome of recurrent increased secretion of antidiuretic hormone following multiple doses of vincristine.

Stuart MJ, Cuaso C, Miller M, Oski FA.

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) has been recognized to occur following treatment with vincristine. None of the reports have provided information regarding its potential for recurrence on further challenge with vincristine (VCR), an agent generally required for repeated use in patients with malignancies. Symptomatic hyponatremia and SIADH that occurred 8 days following administration of VCR in a child with acute lymphatic leukemia was documented with specific radioimmunoassay of urinary ADH levels. The further occurrence of recurrent elevations in ADH excretion 8-10 days following repeated treatment with VCR was also observed. However, SIADH was prevented by prophylactic rigorous fluid restriction. The occurrence of SIADH following VCR therefore does not preclude the further safe usage of this drug.

PMID: 1054263 [PubMed - indexed for MEDLINE]

1: Nouv Presse Med 1979 Jun 9;8(26):2181-5

[Inappropriate secretion of antiduiuretic hormone during acute leukaemia treated with vincristine. Two cases (author's transl)]

[Article in French]

Philip T, Souillet G, Gharib C, Geelen G, Allevard AM, Hartemann E, David M.

One the basis of two special typical cases, the authors detail the symptoms and signs and consider the physiopathology of inappropriate secretion of antidiuretic hormone related to vincristine. Urinary ADH was measured in both cases. ADH levels could be studied on ten consecutive occasions during the course of one of the cases (obs. n 1). Eleven similar cases have been found in the literature. ADH was measured in only three of them. Methods of treatment are considered, with particular emphasis on the role of demeclocycline.

PMID: 112579 [PubMed - indexed for MEDLINE]