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Radiation Toxicity
Published in Frank A. Barile, Barile’s Clinical Toxicology, 2019
Total dose- and rate-dependent effects of radiation—that is, radiation dose per unit of time—result most often in acute cell injury. A single, rapid high dose of radiation may be less injurious if exposure occurs over weeks or months. Injury resulting from exposure also depends on the cumulative body surface area exposed, where acute exposure to high whole-body doses is fatal. In addition, rapidly proliferating cells are more susceptible to the effects of ionizing radiation than cells with a lower turnover rate. Lymphoid, hematopoietic, gonadal, endothelial, osteogenic, and gastrointestinal and pulmonary epithelial cells are most sensitive. Consequently, it is not unreasonable to expect that the initial and persistent adverse reactions associated with cancer radiation therapy will include hair loss, nausea, vomiting, diarrhea, bone marrow suppression, coughing, dyspnea, and dermal changes. Patients with bone marrow suppression have increased susceptibility to infection and bleeding disorders. Sloughing of the epithelial lining of the GI tract, resulting in vomiting and diarrhea, facilitates excessive fluid loss and precipitates electrolyte imbalances. In addition, acute or chronic occupational or accidental exposures to significant doses of ionizing radiation predictably produce skin cancers, leukemias, osteogenic sarcomas, and lung carcinomas.
Liposomal daunorubicin (single-agent)
Published in Maxwell Summerhayes, Susanna Daniels, Practical Chemotherapy, 2018
Maxwell Summerhayes, Susanna Daniels
Bone-marrow suppression. Liposomal formulations are sometimes associated with infusion-related reactions, including back pain, flushing, chest tightness and hypotension. Risk of dilated cardiomyopathy after high cumulative doses (much less common than with conventional anthracyclines). Low incidence of significant nausea, vomiting or alopecia.
Hydroxycarbamide
Published in Sarah H. Wakelin, Howard I. Maibach, Clive B. Archer, Handbook of Systemic Drug Treatment in Dermatology, 2015
Bone marrow suppression. Hydroxycarbamide often causes bone marrow suppression (see below) and is therefore contraindicated in patients with leukopenia: WBC < 2.5 × 109/L; thrombocytopenia: < 100 × 109/L; or severe anaemia.
Pneumocystis jirovecii: a review with a focus on prevention and treatment
Published in Expert Opinion on Pharmacotherapy, 2021
R. Benson Weyant, Dima Kabbani, Karen Doucette, Cecilia Lau, Carlos Cervera
Adverse effects of TMP-SMX at prophylactic doses are relatively common, but usually minor. These include GI upset (nausea, vomiting), skin rash, fever and headache. In the kidney, TMP-SMX can cause interstitial nephritis, in addition to hyperkalemia and elevated creatinine. Hyperkalemia is caused by blockage of the sodium channels in the collecting tubules (similarly to potassium-sparing diuretics). A decreased tubular secretion may cause increased serum creatinine which does not correlate with a decrease in glomerular filtration rate [55]. Less common adverse effects include hepatitis, aseptic meningitis, pancreatitis, hypoglycemia, and hyponatremia [56]. Rarely, TMP-SMX can cause serious and life-threatening reactions such as anaphylaxis, Stevens-Johnson syndrome (SJS), and toxic-epidermal necrolysis (TEN). Bone marrow suppression is also possible and can include neutropenia or pancytopenia. In HSCT patients it is recommended to avoid TMP-SMX during the pre-engraftment period due to potential bone marrow suppression [42]. Hemolytic anemia, another severe adverse effect, has been associated with TMP-SMX use in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Due to the large body of evidence behind TMP-SMX use in PJP, it is generally recommended that for non-life-threatening adverse effects, symptom management (i.e. antihistamines or anti-emetics) or gradual desensitization be attempted before switching therapies [57].
Safety and efficacy of different doses of anthracyclines combined with arsenic trioxide and all-trans retinoic acid in the treatment of de novo acute promyelocytic leukemia
Published in Hematology, 2021
Yaxue Wu, Peng Ke, Haixia Zhou, Depei Wu, Suning Chen, Huiying Qiu, Yue Han, Caixia Li, Xiao Ma, Aining Sun, Xiaowen Tang, Xiaohui Hu
Acute promyelocytic leukemia (APL) is a specific subtype of acute myeloid leukemia (AML) characterized by coagulopathy, high cure rate and sensitivity to anthracyclines, all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) [1]. Over 95% of APL cases are characterized by balanced reciprocal translocation t (15;17), which fuses the PML gene on chromosome 15 to the RAR-α (retinoic acid receptor-α) gene on chromosome 17 [1]. The disease may occur abruptly and is associated with a high risk of early death (ED) mostly due to severe hemorrhages [2]. At present, anthracyclines, ATRA and ATO, are mainly used in induction therapy for APL, which can prolong long-term survival of these patients, significantly reduce recurrence, and control differentiation syndrome (DS) with the addition of chemotherapy drugs [3]. Unfortunately, the combination of these treatment options leads to bone marrow suppression, which increases the risk of infection and bleeding. In addition, the dose of anthracyclines is still controversial, especially in intermediate risk group. Here, we conducted a retrospective multi-center study to evaluate the safety and efficacy of different doses of anthracyclines in the induction treatment of de novo APL.
A retrospective analysis of cisplatin/carboplatin plus paclitaxel in advanced or recurrent cervical cancer
Published in Journal of Obstetrics and Gynaecology, 2019
Dan Song, Weimin Kong, Tongqing Zhang, Chao Han, Tingting Liu, Simeng Jiao, Jiao Chen
No treatment-related death occurred in either group. As shown in Table 3, the major adverse events identified in both groups were gastrointestinal toxicity reaction, bone marrow suppression and renal toxicity. The incidence of Grades III–IV gastrointestinal toxicity reactions was remarkably lower in the TC group than in the TP group (5.7% vs. 23.4%, p = .009). Grades III–IV bone marrow suppression was identified in 15.4% (n = 8) and 7.8% (n = 5) of cases in the TC and TP groups, respectively. Grades III–IV renal toxicity occurred in 3.1% (n = 2) of cases in the TP groups but was not observed in the TC group. The differences in Grades III–IV bone marrow suppression and renal toxicity between the two groups were not significant (p > .05). The main adverse symptoms of bone marrow suppression included avneutropenia, thrombocytopenia and anaemia and their detailed information is shown in Table 4.