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A Case of Accidental Vincristine Overdose and Effective use of Therapeutic Plasma Exchange in Its Management

CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2020; 41(05): 770-772

DOI: DOI: 10.4103/ijmpo.ijmpo_116_20

Abstract

Vincristine is a common drug used in hematological malignancy with a maximum per dose limited to 2 mg mainly to limit neurotoxicity. Vincristine overdose and wrong route of administration, though has been reported in world literature, but its appropriate management is still undefined. We report a case of Hodgkin lymphoma being treated with adriamycin, bleomycin, vinblastine and dacarbazine protocol, where vincristine was accidently administrated instead of vinblastine due to its “look-alike, sound-alike” nature. The patient developed severe toxicity due to the same, which was effectively managed by therapeutic plasma exchange.

Abstract

Vincristine is a common drug used in hematological malignancy with a maximum per dose limited to 2 mg mainly to limit neurotoxicity. Vincristine overdose and wrong route of administration, though has been reported in world literature, but its appropriate management is still undefined. We report a case of Hodgkin lymphoma being treated with adriamycin, bleomycin, vinblastine and dacarbazine protocol, where vincristine was accidently administrated instead of vinblastine due to its “look-alike, sound-alike” nature. The patient developed severe toxicity due to the same, which was effectively managed by therapeutic plasma exchange.

References

  1. Saha AS, Islam MF, Bhattacharya S, Giri PP. Clinical presentation of inadvertent intrathecal vincristine masquerading guillain-barre syndrome. Indian J Hematol Blood Transfus 2016; 32: 59-61
  2. Chae L, Moon HS, Kim SC. Overdose of vincristine: Experience with a patient. J Korean Med Sci 1998; 13: 334-8
  3. Kosmidis HV, Bouhoutsou DO, Varvoutsi MC, Papadatos J, Stefanidis CG, Vlachos P. et al. Vincristine overdose: Experience with 3 patients. Pediatr Hematol Oncol 1991; 8: 171-8
  4. Schwartz J, Padmanabhan A, Aqui N, Balogun RA, Connelly-Smith L, Delaney M. et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing committee of the American Society for Apheresis: The Seventh Special Issue. J Clin Apheresis 2016; 31: 149-62
  5. Ibrahim RB, Balogun RA. Medications and therapeutic apheresis procedures: Are we doing our best?. J Clin Apher 2013; 28: 73-7
  6. Estlin EJ, Ronghe M, Burke GA, Yule SM. The clinical and cellular pharmacology of vincristine, corticosteroids, l-asparaginase, anthracyclines and cyclophosphamide in relation to childhood acute lymphoblastic leukaemia. Br J Haematol 2000; 110: 780-90

Address for correspondence

Dr. Amit Kumar Jain
Department of Medical Oncology, Artemis Hospital
Sector-51, Gurugram - 122 001, Haryana
India   

Publication History

Received: 30 March 2020
Accepted: 29 May 2020
Article published online:
17 May 2021

© 2020. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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References

  1. Saha AS, Islam MF, Bhattacharya S, Giri PP. Clinical presentation of inadvertent intrathecal vincristine masquerading guillain-barre syndrome. Indian J Hematol Blood Transfus 2016; 32: 59-61
  2. Chae L, Moon HS, Kim SC. Overdose of vincristine: Experience with a patient. J Korean Med Sci 1998; 13: 334-8
  3. Kosmidis HV, Bouhoutsou DO, Varvoutsi MC, Papadatos J, Stefanidis CG, Vlachos P. et al. Vincristine overdose: Experience with 3 patients. Pediatr Hematol Oncol 1991; 8: 171-8
  4. Schwartz J, Padmanabhan A, Aqui N, Balogun RA, Connelly-Smith L, Delaney M. et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing committee of the American Society for Apheresis: The Seventh Special Issue. J Clin Apheresis 2016; 31: 149-62
  5. Ibrahim RB, Balogun RA. Medications and therapeutic apheresis procedures: Are we doing our best?. J Clin Apher 2013; 28: 73-7
  6. Estlin EJ, Ronghe M, Burke GA, Yule SM. The clinical and cellular pharmacology of vincristine, corticosteroids, l-asparaginase, anthracyclines and cyclophosphamide in relation to childhood acute lymphoblastic leukaemia. Br J Haematol 2000; 110: 780-90