Chemotherapy Associated Acute Respiratory Failure: a Child With Relapsed Langerhans Cell Histiocytosis
Abstract
Langerhans cell histiocytosis LHH ; is a clonal neoplastic proliferation of Langerhans-type cells with expressing CD1a, langerin and S100 protein and presence of Birbeck granules in the ultrastructural examination. Clinical manifestations are very variable. The bone, bone marrow, skin, lymph nodes, lung, liver, spleen and meninges are most involved. Most cases are diagnosed during childhood and the annual incidence is approximately 5 million. The agent should be selected with the least side effect according to the number of lesions and the area of invasion. Most patients respond to initial treatment. In the last 3.5 years, with the diagnosis of LHH, approximately two years after the end of chemotherapy, the patient referred to our hospital with a central diabetes insipidus. Relapse Langerhans cell histiocytosis was diagnosed as a result of imaging studies. Chemotherapy protocol with cladribine and cytarabine was started for the patient. After the third session/round/cycle of the treatment, pneumonia accompanied by rapid onset of respiratory distress developed after the febrile neutropenia recovered. Here we present a case of sudden respiratory insufficiency after cladribine and/or cytarabine chemotherapy and a dramatic response to steroid treatment
References
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- Kairouz S, Hashash J, Kabbara W, Mchayleh W, Tabbara IA. Dendritic cell neoplasms: An overview. Am J Hematol 2007;82:924–8. [CrossRef]
- Motomura S, Fujisawa S, Fujimaki K, Mohri H, Okubo T. Interstitial pneumonia induced by combination therapy with low‐dose cytarabine and granulocyte colony‐stimulating factor. Am J Hematol 1995;49:364. [CrossRef]
- Matsuno O. Drug-induced interstitial lung disease: mechanisms and best diagnostic approaches. Respir Res 2012;13:39. [CrossRef]
- Leng PH, Murillo B, Fraire A. Acute Interstitial Pneumonitis Occurring After Consolidation Chemotherapy With High Dose Cytarabine For Acute Myelogenous Leukemia. Chest 1999;116:409-10.
- Forghieri F, Potenza L, Morselli M, Maccaferri M, Torelli G, Luppi M. Cytarabine-induced pulmonary toxicity in leukemic patients. In: Azoulay E, editor. Pulmonary Involvement in Patients with Hematological Malignancies. Springer; 2011. p.729–34.
- Mwangi JK, Espiritu JR. Fulminant Organizing Pneumonia Following Cytarabine Treatment For Acute Non-Lymphocytic Leukemia. In: A40. A Hard Day’s Night. Drug Induced Lung Disease. American Thoracic Society; 2015. p.A1546.
- Feenstra JFE, Hickey BP, Blackwell EA. Acute respiratory failure associated with cladribine pneumonitis. Int Med J 2004;34:583–4. [CrossRef]
- Donadieu J, Bernard F, van Noesel M, Barkaoui M, Bardet O, Mura R, et al. Cladribine and cytarabine in refractory multisystem Langerhans cell histiocytosis (LCH): results of an international phase II study. Blood 2015;126:1415–23. [CrossRef]
Abstract
Langerhans hücreli histiositoz LHH , CD1a, langerin ve S100 proteini eksprese eden ve ultrastriktürel incelemede Birbeck granülleri varlığı gösterilen, Langerhans tipi hücrelerin klonal neoplastik proliferasyonudur. Hastalık, klinik olarak çok değişken bir seyir gösterir. En fazla kemik, kemik iliği, cilt, lenf nodları, akciğer, karaciğer, dalak ve meninksler tutulur. Çoğu vaka çocukluk çağında tanı almaktadır, yıllık insidans yaklaşık olarak 5 milyonda birdir. Tutulum bölgesi ve lezyon sayısına göre en az yan etkisi olan ajan ile tedavi seçilmelidir. Hastaların çoğu başlangıç tedavisine yanıt verir. Son 3,5 yıldır Langerhans hücreli histiositoz tanısı ile takipli iken; idame kemoterapinin bitiminden yaklaşık iki yıl sonra hasta santral diabetes insipitus kliniği ile tarafımıza başvurdu. Yapılan görüntüleme tetkikleri neticesinde relaps Langerhans hücreli histiositoz tanısı konuldu. Hastaya kladribin ile sitarabin içeren kemoterapi protokolü başlandı. Bu tedavinin üçüncü küründen sonra, febril nötropenisi düzeldikten sonra ani gelişen ve hızlı ilerleyen solunum sıkıntısının eşlik ettiği pnömoni gelişti. Burada kladribin ve/veya sitarabin kemoterapilerden sonra ani gelişen solunum yetmezliği olan ve steroid tedavisine dramatik cevap alınan bir olgu sunulmuştur
References
- Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon: IARC; 2008.
- Pileri SA, Grogan TM, Harris NL, Banks P, Campo E, Chan JK, et al. Tumours of histiocytes and accessory dendritic cells: an immunohistochemical approach to classification from the International Lymphoma Study Group based on 61 cases. Histopathology 2002;41:1–29. [CrossRef]
- Arico M, Girschikofsky M, Genereau T, Klersy C, McClain K, Grois N, et al. Langerhans cell histiocytosis in adults. Report from the International Registry of the Histiocyte Society. Eur J Cancer 2003;39:2341–8. [CrossRef]
- Minkov M, Prosch H, Steiner M, Grois N, Potschger U, Kaatsch P, et al. Langerhans cell histiocytosis in neonates. Pediatr Blood Cancer 2005;45:802–7. [CrossRef]
- McClain KL. Treatment of langerhans cell histiocytosis. UpToDate. Waltham, MA 2013. https://www.uptodate.com/contents/ treatment-of-langerhans-cell-histiocytosis
- Kairouz S, Hashash J, Kabbara W, Mchayleh W, Tabbara IA. Dendritic cell neoplasms: An overview. Am J Hematol 2007;82:924–8. [CrossRef]
- Motomura S, Fujisawa S, Fujimaki K, Mohri H, Okubo T. Interstitial pneumonia induced by combination therapy with low‐dose cytarabine and granulocyte colony‐stimulating factor. Am J Hematol 1995;49:364. [CrossRef]
- Matsuno O. Drug-induced interstitial lung disease: mechanisms and best diagnostic approaches. Respir Res 2012;13:39. [CrossRef]
- Leng PH, Murillo B, Fraire A. Acute Interstitial Pneumonitis Occurring After Consolidation Chemotherapy With High Dose Cytarabine For Acute Myelogenous Leukemia. Chest 1999;116:409-10.
- Forghieri F, Potenza L, Morselli M, Maccaferri M, Torelli G, Luppi M. Cytarabine-induced pulmonary toxicity in leukemic patients. In: Azoulay E, editor. Pulmonary Involvement in Patients with Hematological Malignancies. Springer; 2011. p.729–34.
- Mwangi JK, Espiritu JR. Fulminant Organizing Pneumonia Following Cytarabine Treatment For Acute Non-Lymphocytic Leukemia. In: A40. A Hard Day’s Night. Drug Induced Lung Disease. American Thoracic Society; 2015. p.A1546.
- Feenstra JFE, Hickey BP, Blackwell EA. Acute respiratory failure associated with cladribine pneumonitis. Int Med J 2004;34:583–4. [CrossRef]
- Donadieu J, Bernard F, van Noesel M, Barkaoui M, Bardet O, Mura R, et al. Cladribine and cytarabine in refractory multisystem Langerhans cell histiocytosis (LCH): results of an international phase II study. Blood 2015;126:1415–23. [CrossRef]
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Case Report |
| Authors | |
| Publication Date | June 1, 2020 |
| Published in Issue | Year 2020Issue: 2 |