title: Idiopathic hyperammonemia after chemotherapy with vinorelbine, topotecan, and cisplatin in a patient with acute lymphocytic leukemia.
abstract: Idiopathic hyperammonemia (IHA) had been reported in some patients with hematological malignancy after receiving intensive chemotherapy, following bone marrow transplantation, or after using 5-fluorouracil for some solid tumors. The chemotherapeutic agents involved include cytarabine, daunomycin, cyclophosphamide, vincristine, amsacrine, etoposide, asparaginase, busulfan, and methotraxate, all used for treating hematological malignancies. No previous reports have described the association between idiopathic hyperammonemia and combined chemotherapy with vinorelbine, topotecan, and cisplatin. We describe a 20-year-old girl with normal liver function and relapsed precursor B-lymphoblastic leukemia receiving the modified TVTG (topotecan, vinorelbine, thiotepa, dexamethasone, and gemcitabine) protocol to control her disease. We used cisplatin (30 mg/m2/day) to replace thiotepa on day 3 because thiotepa was not available in Taiwan. The patient developed acute idiopathic hyperammonemia after 5 days of chemotherapy and died 9 days after chemotherapy. To our knowledge, this patient is the first report of the association of hyperammonemia and chemotherapy with vinorelbine, topotecan, and cisplatin in the English literature.
authors.affiliation: Division of Transfusion Medicine Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, National Defense Center, Taipei, Taiwan.
authors.forename: Yu-Hsien
authors.initials: YH
authors.lastname: Chen
authors.forename: Tzeon-Jye
authors.initials: TJ
authors.lastname: Chiou
authors.forename: Yen-Ning
authors.initials: YN
authors.lastname: Hsu
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Liu
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002945:Cisplatin / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D022124:Hyperammonemia / Q000209:etiology*; D008099:Liver / Q000473:pathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D019772:Topotecan / Q000009:adverse effects* / Q000627:therapeutic use; D014747:Vinblastine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077235:Vinorelbine; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D014747:Vinblastine; D019772:Topotecan; D002945:Cisplatin; D000077235:Vinorelbine