title: Successful dexrazoxane treatment of a potentially severe extravasation of concentrated doxorubicin.
abstract: Dexrazoxane is now authorized for the treatment of anthracycline extravasations. Several clinical cases of doxorubicin extravasation treated with dexrazoxane have been reported to date, but detailed cases have not been published. We report a case of a successful dexrazoxane treatment for a potentially severe extravasation of concentrated doxorubicin. We also describe objective outcome of this treatment, drug tolerance to dexrazoxane and long follow-up. A 29-year-old man diagnosed with Hodgkin's lymphoma was prescribed a regimen including 90 mg of doxorubicin in a 50 ml infusion using a reduced occlusion infusion pump. After this infusion, the patient complained of pain around the site of injection and presented a 10x6-cm swollen area with erythema and inflammation. A significant portion of doxorubicin was extravasated. Dexrazoxane was prescribed as an antidote. Side effects of dexrazoxane were restricted to reversible hematological toxicity, nausea, and vomiting. The next day, the inflammation of the extravasation area was reduced. On day 7, a painless mild induration in the extravasated area was the only remaining sign of the extravasation. On day 40, an arm nuclear magnetic resonance image showed no focal injuries. At 6-month follow-up, the patient has no sequelae. The two risk factors that could have increased the severity of the extravasation are the use of an infusion pump and the high drug concentration. Dexrazoxane proved to be effective and moderately well tolerated. A dexrazoxane stock in oncological facilities could help to promptly handle emergencies like this. Anthracyclines can be administered using reduced occlusion infusion pumps, but it seems preferable to always administer a free-running infusion to minimize accidents like this one.
authors.affiliation: Department of Pharmacy, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain. dconde@hospitaldelmar.cat
authors.forename: David
authors.initials: D
authors.lastname: Conde-Estévez
authors.forename: Silvia
authors.initials: S
authors.lastname: Saumell
authors.forename: Antonio
authors.initials: A
authors.lastname: Salar
authors.forename: Javier
authors.initials: J
authors.lastname: Mateu-de Antonio
mesh_terms: D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis / Q000188:drug therapy*; D006689:Hodgkin Disease / Q000188:drug therapy*; D006801:Humans; D008297:Male; D011929:Razoxane / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000903:Antibiotics, Antineoplastic; D011929:Razoxane; D004317:Doxorubicin