Azacitidine-associated pleuropericardial effusion in myelodysplastic syndrome: A case report

Goo, Kelli; Uy, Rosalynda; Roswarski, Joseph

doi:10.1177/1078155218784762

Cited by 8 publications

(13 citation statements)

References 25 publications

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“…Epigenetic changes on the genome of MDS patients, leading to the silencing of many crucial differentiation genes are reversed, following a favorable response to AZA treatment. 6 Demethylation by azacytidine may reduce the stability of silencing signals and confer relative activation of genes, involved in angiogenesis, 7 like in our case. The heterogeneity of MDS, combined with the unpredictable pharmacological action of AZA may have contributed to the generation of this hyper-angiogenic lesion.…”

mentioning

confidence: 59%

Rare lobular capillary hemangioma associated with azacitidine in high‐risk myelodysplastic syndrome patient

Grafanaki

Kourakli

Skeparnias

et al. 2021

Dermatologic Therapy

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Lobular capillary hemangioma (LCH), also known as pyogenic granuloma, is a benign vascular proliferative lesion of both, skin, and mucosa, which may occur in response to various stimuli, such as trauma or drugs. 1 Azacitidine (AZA) is a cytidine analog, used as an interventional treatment of myelodysplastic syndromes (MDS). It exhibits antineoplastic action, either through incorporation into RNA and DNA or as an inhibitor of DNA-methyltransferases (DNMTs), which restores normal growth control and differentiation in hematopoietic cells. 2 A 75-year-old Caucasian male was referred to the Dermatology Department with a history of hypertension, gout, and recent onset of high-risk MDS, namely, Refractory Anemia with Excess Blasts (EB) under AZA treatment. The patient reported a painless large red dome-shaped mass with hemorrhagic crust, sprouting at the right inner ankle, after receiving subcutaneously administered AZA (75 mg/

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mentioning

confidence: 59%

Rare lobular capillary hemangioma associated with azacitidine in high‐risk myelodysplastic syndrome patient

Grafanaki

Kourakli

Skeparnias

et al. 2021

Dermatologic Therapy

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“…Cardiac toxicity was also observed in patients treated with decitabine, another hypomethylating agent . An immune reaction or dose‐dependent toxicity have also been suggested as a possible mechanism. Even though in vitro studies cannot be extrapolated to exposure in humans, a potential effect of AZA on human cardiac cells cannot be excluded.…”

Section: Discussionmentioning

confidence: 99%

“…In the literature, some data on cardiac disorders associated with AZA such as atrial fibrillation and pleuro‐pericardial effusion were retrieved (see Table ), but with a frequency below 5%. Furthermore, data about the occurrence of CF in patients treated with AZA are scarce.…”

Section: Discussionmentioning

confidence: 99%

Cardiac failure in patients treated with azacitidine, a pyrimidine analogue: Case reports and disproportionality analyses in Vigibase

Perino

Mottal

Bohbot

et al. 2020

Brit J Clinical Pharma

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Aims: Azacitidine (AZA), a pyrimidine analogue, is validated for high-risk myelodysplastic syndrome or low-blast acute myeloid leukaemia in unfit patients for more intensive treatment. This study assessed the putative link between cardiac failure (CF) and AZA exposure.Methods: Cases of CF in patients treated with AZA were retrospectively collected and described from several centres of the Groupe Francophone des Myélodysplasies. A description analysis and a disproportionality analysis using Vigibase, the WHO Global Individual Case Safety Reports (ICSRs) database, were conducted on ICSRs by the Standardized MedDRA Queries (SMQ broad) cardiac failure and by preferred terms cardiac failure and cardiac failure acute. The reported odds ratio (ROR) and its 95% 2-sided confidence interval was computed by comparing the proportion of CF reports with the suspected drug (AZA) and the proportion of reports of the same adverse drug reaction with all other suspected drugs in the database during the same period. Results:In the 4 case reports, all patients presented a cardiovascular history. In 1 patient, CF recurred after AZA re-challenge. The pharmacovigilance analysis in Vigibase retrieved 307 ICSRs of CF (SMQ) with AZA. Significant disproportionality signals associated with AZA were identified by using the SMQ cardiac failure (ROR 1.3) and the preferred terms cardiac failure (ROR 5.1) and cardiac failure acute (ROR 23.2). Conclusion:This study points to the potential role of AZA in the occurrence of CF. Cardiac evaluation before AZA initiation and regular monitoring of cardiac function during AZA treatment should be performed in patients with a history of cardiovascular disease. K E Y W O R D Santicancer drugs, drug safety, heart failure

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“…Azacitidine's DNA hypomethylating effect improves the rates of partial and complete hematological response and decreases the rate of transformation to AML in adult myelodysplastic syndrome (MDS) cases and has thus become the standard of care in higher risk patients. 4 Its therapeutic advantages, with partial or complete bone marrow response in most patients, have been demonstrated in children with advanced MDS prior to HSCT, 2 and its usage in this setting has been increasing. In children with advanced MDS eligible for HSCT, treatment with azacitidine prior to HSCT is associated with a decrease in blast counts or even with remission.…”

Section: Discussionmentioning

confidence: 99%

“…3 Hypomethylating agents have been implicated in cardiotoxicity, but there have been rare reports of azacitidine-induced large PE in adults, with or without associated pericarditis. 4 To the best of our knowledge no cases have been reported in children so far.…”

Section: Introductionmentioning

confidence: 93%

Azacitidine-induced massive pericardial effusion in a child with myelodysplastic syndrome

Mata

Martins

Rato

et al. 2022

J Oncol Pharm Pract

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Introduction Pericardial effusions are rare yet potentially fatal conditions in children. Azacitidine is a DNA-hypomethylating agent used in the treatment of myelodysplastic syndrome. Although seldomly described in adults, no cases of azacitidine-induced pericardial effusion have been reported in children. Case report A 7-year-old boy with myelodysplastic syndrome presented with a large pericardial effusion with risk for cardiac tamponade after his first azacitidine cycle. Management & outcome The patient was admitted to a pediatric ICU, antibiotic and steroid therapy were initiated. Pericardiocentesis was done due to hemodynamic instability. Serum and pericardial fluid complementary evaluation excluded infectious and malignant causes. The pericardial effusion did not reappear and additional pleural and ascitic slight effusions responded well to diuretics. Follow-up azacitidine cycles were administered by tapering daily dosages and using adjunctive steroid therapy, with no additional adverse events. Discussion We report the first pediatric case of large pericardial effusion secondary to azacitidine therapy in a child with MDS. This adverse reaction has not been described in pediatric patients, in which this therapeutic option has been increasingly used. We seek to raise awareness on the potential life-threatening cardiotoxicity of azacitidine in pediatric patients.

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Azacitidine-associated pleuropericardial effusion in myelodysplastic syndrome: A case report

Cited by 8 publications

References 25 publications

Rare lobular capillary hemangioma associated with azacitidine in high‐risk myelodysplastic syndrome patient

Rare lobular capillary hemangioma associated with azacitidine in high‐risk myelodysplastic syndrome patient

Cardiac failure in patients treated with azacitidine, a pyrimidine analogue: Case reports and disproportionality analyses in Vigibase

Azacitidine-induced massive pericardial effusion in a child with myelodysplastic syndrome

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