Critical Care Medicine-Hematologic and Oncologic Disorders>>>>>Complications of Immunosuppressive Drugs and Chemotherapy
Question 5#

A 63-year-old man with multiple myeloma is admitted to the ICU with neutropenic fever following melphalan treatment in advance of autologous stem cell treatment.

Which of the following toxicities are not commonly associated with alkylating agents? 

A. Enterocolitis
B. Pancytopenia
C. Elevated transaminases
D. Mucositis
E. Cardiac toxicity

Correct Answer is E

Comment:

Correct Answer: E

Alkylating agents include a broad array of chemically diverse drugs that cause cross-linking of DNA in all cells, but have their greatest effect in rapidly dividing cells. Common side effects include pancytopenia, infertility, mucosal injury, alopecia, and increased risk of malignancy. Less common toxicities include hepatic veno-occlusive disease (hepatomegaly, RUQ pain, jaundice, and ascites), pulmonary fibrosis, and hemorrhagic cystitis. Cardiac toxicity occurs but is rare in comparison to the anthracyclines. The dose-limiting toxicity of the alkylating agents is to the bone marrow, with the nadir of neutropenia between 8 and 16 days postadministration followed by recovery at approximately 21 days. 

References:

  1. Colvin M. Alkylating agents. Holland-Frei Cancer Medicine. 6th ed. 2003.
  2. Chatterjee K, Zhang J, Honbo N, Karliner JS. Doxorubicin Cardiomyopathy. Cardiology. 2010;115:155-162.