title: Femoral head necrosis in three patients with relapsed ovarian cancer receiving high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation.
abstract: We report three patients with relapsed ovarian cancer who developed femoral head necrosis requiring endoprosthetic hip surgery 16-35 months after high-dose chemotherapy (HDC) with treosulfan (47 and 56 g/m(2) body-surface area (BSA)) given as 3-25 h infusions and followed by autologous peripheral blood stem cell (PBSC) transplantation. One woman received two courses of single agent treosulfan while the other two patients received one course of high-dose treosulfan either preceded or followed by high-dose carboplatin, etoposide and cyclophosphamide. A total of 30 women with ovarian cancer were treated with HDC at our unit and 21 of them received treosulfan-containing regimens. Femoral head necrosis was not observed in patients either receiving conditioning regimens without treosulfan (n=9) or when the total treosulfan dose was given over 3 consecutive days (n=3) or in patients with a diagnosis other than ovarian cancer and treated with high-dose treosulfan (n=10). We conclude that women with relapsed ovarian cancer receiving HDC with excessive single-dose treosulfan might be at an increased risk of developing bone necrosis.
authors.affiliation: Department of Internal Medicine, University of Essen Medical School, Essen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Bojko
authors.forename: R A
authors.initials: RA
authors.lastname: Hilger
authors.forename: S G
authors.initials: SG
authors.lastname: Ruehm
authors.forename: O
authors.initials: O
authors.lastname: Dirsch
authors.forename: S
authors.initials: S
authors.lastname: Seeber
authors.forename: M E
authors.initials: ME
authors.lastname: Scheulen
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000188:drug therapy*; D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects*; D002066:Busulfan / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives*; D003131:Combined Modality Therapy; D005260:Female; D005271:Femur Head Necrosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010051:Ovarian Neoplasms / Q000150:complications / Q000188:drug therapy*; D011859:Radiography
chemical_list: D018906:Antineoplastic Agents, Alkylating; C018404:treosulfan; D002066:Busulfan