Multi-Organ Adverse Reaction to Two Hypomethylating Agents: A Challenge in High-Risk Myelodysplastic Syndrome Treatment.

IF 1.1 Q4 HEMATOLOGY
Sofia Brites Alves, Francesca Pierdomenico
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引用次数: 0

Abstract

Background and Clinical Significance: Intermediate- to high-risk Myelodysplastic Syndrome (MDS), according to the Revised International Prognostic Scoring System (IPSS-M), confers a high risk of progression into acute myeloid leukemia. Treatment with hypomethylating agents, including azacitidine and decitabine, represents the current standard of care. In eligible patients, hypomethylating agents are used as a bridge for allogeneic stem cell transplantation, currently the only curative approach in these malignancies. The most common side effects of hypomethylating agents are myelosuppression, cutaneous injection site reactions (when azacitidine is given subcutaneously), and gastrointestinal symptoms. Uncommon, disabling, and long-lasting side effects represent a threat to effective treatment in this group of patients. Case Presentation: We describe the case of a 49-year-old male patient with IPSS-M intermediate-risk MDS, intended to receive first-line treatment with azacitidine followed by allogeneic stem cell transplantation. The first, late-onset azacitidine reaction was observed 48 h after the first exposure, with cutaneous and respiratory toxicity, followed by the late-onset recurrence of symptoms after azacitidine withdrawal and decitabine introduction. Conclusions: This case highlights atypical, disabling, and long-lasting drug reactions to two hypomethylating agents, with the persistence of hypersensitivity manifestations months after medication withdrawal.

两种低甲基化药物的多器官不良反应:高风险骨髓增生异常综合征治疗的挑战。
背景和临床意义:根据修订的国际预后评分系统(IPSS-M),中高风险骨髓增生异常综合征(MDS)具有发展为急性髓系白血病的高风险。使用低甲基化药物治疗,包括阿扎胞苷和地西他滨,是目前的标准治疗方法。在符合条件的患者中,低甲基化药物被用作同种异体干细胞移植的桥梁,这是目前治疗这些恶性肿瘤的唯一方法。低甲基化药物最常见的副作用是骨髓抑制、皮肤注射部位反应(当皮下给予阿扎胞苷时)和胃肠道症状。罕见的、致残的和持久的副作用对这组患者的有效治疗构成威胁。病例介绍:我们描述了一例49岁男性IPSS-M中危MDS患者,打算接受阿扎胞苷的一线治疗,然后进行同种异体干细胞移植。第一次迟发性阿扎胞苷反应发生在首次暴露48小时后,伴有皮肤和呼吸毒性,随后停药阿扎胞苷和引入地西他滨后出现迟发性症状复发。结论:该病例突出了对两种低甲基化药物的非典型、致残和持久的药物反应,在停药后几个月仍有持续的过敏表现。
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来源期刊
Hematology Reports
Hematology Reports HEMATOLOGY-
CiteScore
0.90
自引率
0.00%
发文量
47
审稿时长
10 weeks
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