Veno-occlusive disease in pediatric patients receiving actinomycin D and vincristine only for the treatment of rhabdomyosarcoma.
OBJECTIVE
Veno-occlusive disease (VOD) following standard chemotherapy has been reported in patients receiving vincristine actinomycin D, and cyclophosphamide for the treatment of Wilms tumor and more rarely rhabdomyosarcoma. The dose and schedule of administration of actinomycin D in patients with Wilms tumor and the increased dose of cyclophosphamide administered to patients with rhabdomyosarcoma have been considered the likely etiology for VOD.


METHODS
The authors report four cases of VOD in patients with rhabdomyosarcoma treated with vincristine and actinomycin D only. No risk factors for the development of VOD were identified. VOD was diagnosed clinically by the presence of at least two of three findings as defined by McDonald et al. VOD occurred after two to four doses of actinomycin D and approximately 7 to 14 days after the dose. All patients recovered with no evidence of permanent hepatic damage.


CONCLUSIONS
VOD can occur in patients with "low-stage" rhabdomyosarcoma treated with vincristine and actinomycin D alone. Although chemotherapy-related VOD is a potentially severe disease, the outcome is good and resumption of chemotherapy is well tolerated.
Sulis
Maria Luisa
ML
Division of Pediatric Oncology, Children's Hospital of New York, Columbia University, 161 Fort Washington Avenue, Irving Pavilion 7, New York, NY 10032, USA. mls95@columbia.edu
Bessmertny
Olga
O
Granowetter
Linda
L
Weiner
Michael
M
Kelly
Kara M
KM
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use*; D002675:Child, Preschool; D003609:Dactinomycin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006504:Hepatic Veno-Occlusive Disease / Q000139:chemically induced*; D006801:Humans; D007223:Infant; D008297:Male; D012208:Rhabdomyosarcoma / Q000188:drug therapy*; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
D003609:Dactinomycin; D014750:Vincristine