Cardiotoxicity following cyclophosphamide therapy: a case report

Journal of Medical Case Reports

Aylin Ozsancak Ugurlu³  Oyku Gulmez¹  Figen Atalay² 

[1] Department of Cardiology, Baskent University Istanbul Medical and Research Center, İstanbul, Turkey;Department of Hematology, Baskent University Istanbul Medical and Research Center, İstanbul, Turkey;Department of Pulmonary Medicine, Baskent University Istanbul Medical and Research Center, İstanbul, Turkey

关键词: Lymphoma therapy;    Cyclophosphamide;    Cardiotoxicity;   

Others  :  1181100
DOI  :  10.1186/1752-1947-8-252

 received in 2013-12-13, accepted in 2014-06-02,  发布年份 2014

【 摘 要 】

Introduction

Cardiac toxicity is one of the life-threatening complications of cancer therapy. Systemic anticancer treatments may exert their own toxic effects or can aggravate adverse effects of other drugs. We report a case of cyclophosphamide-induced cardiotoxicity in a patient with normal cardiac functions before chemotherapy.

Case presentation

A 66-year-old Caucasian woman with a mediastinal mass diagnosed with Burkitt lymphoma underwent chemotherapy with rituximab-hyperfractionated-cyclophosphamide-vincristine-doxorubicin-dexamethasone. On the seventh day of chemotherapy, she developed dyspnea. An electrocardiogram demonstrated low voltage in the limb and precordial leads. It also showed diffusely increased myocardial echogenicity, mild pericardial and pleural effusion, generally impaired biventricular systolic functions with a left ventricular ejection fraction of 31%, and right ventricular mid-apical akinesia, even though she had normal biventricular functions before chemotherapy. Cyclophosphamide-induced cardiotoxicity was suspected and she was given treatment for congestive heart failure. Her dyspnea decreased and she was discharged on the tenth day with a left ventricular ejection fraction of 37% and normal right ventricular function. After 1 month, echocardiography showed normal biventricular functions with a left ventricular ejection fraction of 60%.

Conclusions

Drug-induced cardiotoxicity, therefore, should be taken into consideration when using cyclophosphamide therapy, especially when anthracyclines are co-administered. Close communication between hematologists and cardiologists is required.

【 授权许可】

   
2014 Atalay et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Morandi P, Ruffini PA, Benvenuto GM, Raimondi R, Fosser V: Cardiac toxicity of high dose chemotherapy. Bone Marrow Transplant 2005, 35:323-334.
• [2]Yeh ET, Tong AT, Lenihan DJ, Yusuf SW, Swafford J, Champion C, Durand JB, Gibbs H, Zafarmand AA, Ewer MS: Cardiovascular complication of cancer therapy: diagnosis, pathogenesis, and management. Circulation 2004, 109:3122-3131.
• [3]Slordal L, Spigset O: Heart failure induced by non-cardiac drugs. Drug Saf 2006, 29:567-586.
• [4]Goldberg MA, Antin JH, Guinan EC, Rappeport JM: Cyclophosphamide cardiotoxicity: an analysis of dosing as a risk factor. Blood 1986, 68:1114-1118.
• [5]Senkus E, Jassem J: Cardiovascular effects of systemic cancer treatment. Cancer Treat Rev 2011, 37:300-311.
• [6]Katayama M, Imai Y, Hashimoto H, Kurata M, Nagai K, Tamita K, Morioka S, Furukawa Y: Fulminant fatal cardiotoxicity following cyclophosphamide therapy. J Cardiol 2009, 54:330-334.
• [7]Arunprasath P, Gobu P, Dubashi B, Satheesh S, Balachander J: Rituximab induced myocardial infarction: a fatal drug reaction. J Cancer Res Ther 2011, 7:346-348.
• [8]Foran JM, Rohaitner AZ, Cunningham D, Popescu RA, Solal-Celigny P, Ghielmini M, Coiffier B, Johnson PW, Gisselbrecht C, Reyes F, Radford JA, Bessell EM, Souleau B, Benzohra A, Lister TA: European Phase II study of rituximab (chimeric anti-CD20 monoclonal antibody) for patients with newly diagnosed mantle cell lymphoma and previously treated mantle cell lymphoma, immunocytoma, and small B lymphocytic lymphoma. J Clin Oncol 2000, 18:317-324.
• [9]Kilickap S, Yavuz B, Aksoy S, Sahiner L, Dincer M, Harputluoglu H, Erman M, Aytemir K, Tokgozoglu L, Barista I: Addition of rituximab to chop does not increase the risk of cardiotoxicity in patients with non-Hodgkin’s lymphoma. Med Oncol 2008, 25:437-442.