title: Polychemotherapy of acute myelogenous leukemia in a patient with acute intermittent porphyria.
abstract: The safety of drugs in hepatic porphyrias has largely been established by clinical experience, which is very limited in the case of antineoplastic agents. We administered three cycles of polychemotherapy consisting of daunorubicin, cytarabine and 6-thioguanine, and modified supportive care to a 33-year-old Turkish woman suffering from acute myelogenous leukemia. The urinary excretion of total porphyrins, porphobilinogen, and aminolevulinic acid was continuously monitored. Excretion of these metabolites was permanently elevated, but the values were comparatively low during cytotoxic therapy while peak values were recorded at the onset of fever during bone marrow aplasia; yet there were no clinical signs of porphyritic attacks at that time. A few potentially unsafe drugs were tolerated without an increase in porphyrin excretion. Although the susceptibility to drugs is highly variable in patients with hepatic porphyrias, the treatment of malignancy in these patients seems justified as long as porphyrin excretion under therapy is not grossly elevated over baseline values and appropriately modified supportive care is administered.
authors.forename: A
authors.initials: A
authors.lastname: Wehmeier
authors.forename: J T
authors.initials: JT
authors.lastname: Fischer
authors.forename: G
authors.initials: G
authors.lastname: Goerz
authors.forename: W
authors.initials: W
authors.lastname: Schneider
mesh_terms: D000208:Acute Disease; D000328:Adult; D000622:Aminolevulinic Acid / Q000652:urine; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008107:Liver Diseases / Q000652:urine; D008936:Mitolactol / Q000008:administration & dosage / Q000009:adverse effects; D011162:Porphobilinogen / Q000652:urine; D011164:Porphyrias / Q000139:chemically induced* / Q000652:urine; D011166:Porphyrins / Q000652:urine; D012306:Risk; D013629:Tamoxifen / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D011166:Porphyrins; D013629:Tamoxifen; D011162:Porphobilinogen; D004317:Doxorubicin; D000622:Aminolevulinic Acid; D008936:Mitolactol