Multiple Severe Toxicities of L-Asparaginase and Their Innovative Management during Induction Therapy of Acute Lymphoblastic Leukemia in an Adult Patient
L-asparaginase is a key chemotherapeutic agent in acute lymphoblastic leukemia (ALL). It is also known for multiple and severe specific toxicities, without consensual management. We report the case of a 51-year-old man treated with L-asparaginase for recently diagnosed T-cell ALL. During the treatme...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Case Reports in Hematology |
| Online Access: | http://dx.doi.org/10.1155/2019/9086570 |
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| author | Guillaume Beziat Suzanne Tavitian Muriel Picard Stanislas Faguer Christian Recher Françoise Huguet |
| author_facet | Guillaume Beziat Suzanne Tavitian Muriel Picard Stanislas Faguer Christian Recher Françoise Huguet |
| author_sort | Guillaume Beziat |
| collection | DOAJ |
| description | L-asparaginase is a key chemotherapeutic agent in acute lymphoblastic leukemia (ALL). It is also known for multiple and severe specific toxicities, without consensual management. We report the case of a 51-year-old man treated with L-asparaginase for recently diagnosed T-cell ALL. During the treatment, he developed a coma due to multifactorial diffuse cerebral edema, by hepatic encephalopathy, cerebral venous thrombosis, and hyperammonemia, all linked to toxicity of L-asparaginase. Specific and innovative treatments were employed to manage these toxicities: supplementation with L-carnitine, thiamine, and pyridoxine for hepatic toxicity, perfusion of sodium benzoate to decrease ammonemia, and extrahepatic albumin-based dialysis sessions, along with anticoagulation. The patient improved within two weeks and is currently alive 13 months later, in first complete remission, without sequelae, on an alleviated chemotherapy regimen. |
| format | Article |
| id | doaj-art-431f93f1a48c47e4b38b76b846cc80b2 |
| institution | Kabale University |
| issn | 2090-6560 2090-6579 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Hematology |
| spelling | doaj-art-431f93f1a48c47e4b38b76b846cc80b22025-08-20T03:35:57ZengWileyCase Reports in Hematology2090-65602090-65792019-01-01201910.1155/2019/90865709086570Multiple Severe Toxicities of L-Asparaginase and Their Innovative Management during Induction Therapy of Acute Lymphoblastic Leukemia in an Adult PatientGuillaume Beziat0Suzanne Tavitian1Muriel Picard2Stanislas Faguer3Christian Recher4Françoise Huguet5Service d’Hématologie Clinique, Institut Universitaire du Cancer Oncopole, Toulouse, FranceService d’Hématologie Clinique, Institut Universitaire du Cancer Oncopole, Toulouse, FranceRéanimation et Soins Intensifs, Institut Universitaire du Cancer Oncopole, Toulouse, FranceSecteur de Réanimation de l’Unité de Transplantation d’Organes, CHU Rangueil, Toulouse, FranceService d’Hématologie Clinique, Institut Universitaire du Cancer Oncopole, Toulouse, FranceService d’Hématologie Clinique, Institut Universitaire du Cancer Oncopole, Toulouse, FranceL-asparaginase is a key chemotherapeutic agent in acute lymphoblastic leukemia (ALL). It is also known for multiple and severe specific toxicities, without consensual management. We report the case of a 51-year-old man treated with L-asparaginase for recently diagnosed T-cell ALL. During the treatment, he developed a coma due to multifactorial diffuse cerebral edema, by hepatic encephalopathy, cerebral venous thrombosis, and hyperammonemia, all linked to toxicity of L-asparaginase. Specific and innovative treatments were employed to manage these toxicities: supplementation with L-carnitine, thiamine, and pyridoxine for hepatic toxicity, perfusion of sodium benzoate to decrease ammonemia, and extrahepatic albumin-based dialysis sessions, along with anticoagulation. The patient improved within two weeks and is currently alive 13 months later, in first complete remission, without sequelae, on an alleviated chemotherapy regimen.http://dx.doi.org/10.1155/2019/9086570 |
| spellingShingle | Guillaume Beziat Suzanne Tavitian Muriel Picard Stanislas Faguer Christian Recher Françoise Huguet Multiple Severe Toxicities of L-Asparaginase and Their Innovative Management during Induction Therapy of Acute Lymphoblastic Leukemia in an Adult Patient Case Reports in Hematology |
| title | Multiple Severe Toxicities of L-Asparaginase and Their Innovative Management during Induction Therapy of Acute Lymphoblastic Leukemia in an Adult Patient |
| title_full | Multiple Severe Toxicities of L-Asparaginase and Their Innovative Management during Induction Therapy of Acute Lymphoblastic Leukemia in an Adult Patient |
| title_fullStr | Multiple Severe Toxicities of L-Asparaginase and Their Innovative Management during Induction Therapy of Acute Lymphoblastic Leukemia in an Adult Patient |
| title_full_unstemmed | Multiple Severe Toxicities of L-Asparaginase and Their Innovative Management during Induction Therapy of Acute Lymphoblastic Leukemia in an Adult Patient |
| title_short | Multiple Severe Toxicities of L-Asparaginase and Their Innovative Management during Induction Therapy of Acute Lymphoblastic Leukemia in an Adult Patient |
| title_sort | multiple severe toxicities of l asparaginase and their innovative management during induction therapy of acute lymphoblastic leukemia in an adult patient |
| url | http://dx.doi.org/10.1155/2019/9086570 |
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