Autonomic neuropathy after treatment with cisplatin, vinblastine, and bleomycin for germ cell cancer.

Hansen, Steen Werner

doi:10.1136/bmj.300.6723.511

Cited by 47 publications

(24 citation statements)

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“…Autonomic neuropathy in patients with Hodgkin lymphoma is probably a paraneoplastic phenomenon [15]. This could be aggravated by chemotherapy such as vinblastine or bleomycin, known to cause peripheral autonomic neuropathy [19], explaining the development of hypothermia after chemotherapy administration. Thus, autonomic neuropathy is a plausible mechanism, overt in some cases and perhaps subclinical in others.…”

Section: Discussionmentioning

confidence: 99%

Hodgkin Lymphoma and Hypothermia: Case Report and Review of the Literature

et al. 2013

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We report the development of hypothermia in a patient with Hodgkin lymphoma which resolved with chemotherapy administration. A review of the literature revealed 16 previous reports of hypothermia in patients with Hodgkin lymphoma. Overall prognosis seems to be unfavorable. To the best of our knowledge this is the first report of hypothermia in a patient with Hodgkin lymphoma transforming from chronic lymphocytic leukemia (Richter's syndrome). A possible pathophysiology could be paraneoplastic autonomic neuropathy. Physicians should be aware that Hodgkin lymphoma can present with hypothermia and should carefully monitor newly diagnosed patients with advanced disease for this complication. Likewise, patients with Hodgkin lymphoma who develop hypothermia should be screened for signs of autonomic neuropathy.

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Section: Discussionmentioning

confidence: 99%

Hodgkin Lymphoma and Hypothermia: Case Report and Review of the Literature

et al. 2013

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“…33,34 There is still som e uncertainty whether the m ajor cisplatininduced dam age to the hum an sensory peripheral nerves is at the level of the cell body, the axo n, or both. Although cisplatin toxicity is know n to involve predom inantly large-diam eter sensory ® bres, an autonom ic neuropathy has been described 14,35 occurring in patients receiving a com bination of cisplatin, vinblastine and bleom ycin, and this has been postulated to be a`dying back' sm all-® bre neuropathy. A m otor com ponent to the neuropathy has been reported to occur in som e patients receiving high doses of cisplatin.…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Neurotoxicity of Chemotherapy in Adolescents and Young Adults Treated for Bone and Soft Tissue Sarcomas

Earl

Connolly

Latoufis

et al. 1998

Sarcoma

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Purpose. To study the long-term neurotoxicity of chemotherapy in adolescents and young adults treated for bone and soft tissue sarcomas.Patients and Methods. Thirty-six adolescents and young adults (median age 17 years) were examined following chemotherapy for bone and soft tissue sarcomas. Twenty-nine (29/36) had received cisplatin (median 400 mg/m(2)), 15/36 ifosfamide (median 20 g/m(2)), and 12/36 vincristine (median 16 mg). Neurotoxicity was assessed at a median of 8 months (range, 1-54 months) after completion of chemotherapy by clinical examination, nerve conduction studies, audiograms and autonomic function tests. The same nerve conduction studies were carried out in 20 normal volunteers to define normal ranges in this age group.Results. Sixteen patients (44%) had a significant reduction in deep tendon reflexes, and this clinical parameter correlated well with abnormalities detected in nerve conduction studies. Vibration perception threshold (VPT) was raised in 20/36 patients (55%) and this was the most sensitive single test in the assessment of neuropathy. There was a significant correlation between VPT and cumulative cisplatin dose received in mg/m(-2) (r=0.607, p<0.01). Ten of 29 patients (35%) had abnormal nerve conduction studies with a pattern characteristic of sensory axonal neuropathy. No patient complained of auditory symptoms, but minor high tone hearing loss was detected by audiograms in 5/28 patients who had received cisplatin. No patients had symptoms of autonomic neuropathy, but autonomic function tests showed minor abnormalities in 4/22 patients tested, and all had received cisplatin.Conclusions. This study demonstrates significant, although asymptomatic, long-term neurotoxicity of cisplatin in adolescents and young adults receiving chemotherapy for bone and soft tissue sarcomas. Follow-up studies are planned to assess whether these neurological deficits improve with time.

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“…Finally, the other patient, a 72-year-old, had a borderline Valsalva ratio (1.31) even before cisplatJn treatment started, indicating a possible autonomic dysfunction from the onset. Hansen observed a dysfunction of the parasympathetic nerves in 10 out of 28 patients, based on the heart rate response to standing, to Valsalva's manoeuvre and to deep breathing [1]. Eight of the ten patients however, had an abnormal result in one out of the 3 tests, indicating only minimal damage, whilst the only complaint related to autonomic dysfunction was impotence in three patients.…”

Section: Discussionmentioning

confidence: 99%

“…Many patients will develop a peripheral sensory neuropathy, predominantly of large myelinated fibres [1].…”

Section: Introductionmentioning

confidence: 99%

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Cisplatin-induced autonomic neuropathy: does it really exist?

et al. 1996

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The neurotoxic side-effects of cisplatin affect predominantly the large, myelinated fibres of peripheral nerves, leading to a sensory neuropathy. Several reports of cisplatin-associated autonomic neuropathy have been published. Autonomic dysfunction however, is caused by a neuropathy of small unmyelinated nerve fibres. By using the absolute pupil diameter as a parameter of autonomic nervous system function, we studied autonomic neuropathy in the eye of cisplatin-intoxicated rats. In addition, we examined autonomic cardiovascular function by measuring the change in heart rate (HR) and mean arterial blood pressure (MAP) in response to intravenous phenylephrine (PHE) and tyramine (TYR). No significant differences in mean pupil diameter developed in cisplatin-intoxicated rats (n = 12) in the course of 9 weeks (total cumulative dose cisplatin 18 mg/kg) compared with normal controls (n = 9) MANOVA, F1,19 = 0.88, P < 0.36). The PHE- and TYR-induced changes in MAP and HR were virtually the same in cisplatin-intoxicated rats when compared with normal controls. We conclude that cisplatin probably does not cause autonomic dysfunction, at least not in rats, in doses commonly used and which are known to cause a peripheral sensory neuropathy.

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Autonomic neuropathy after treatment with cisplatin, vinblastine, and bleomycin for germ cell cancer.

Cited by 47 publications

References 4 publications

Hodgkin Lymphoma and Hypothermia: Case Report and Review of the Literature

Hodgkin Lymphoma and Hypothermia: Case Report and Review of the Literature

Long‐Term Neurotoxicity of Chemotherapy in Adolescents and Young Adults Treated for Bone and Soft Tissue Sarcomas

Cisplatin-induced autonomic neuropathy: does it really exist?

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