Cyclophosphamide intoxication because of pharmacy error in two dogs

Wells, Jennifer E; Sabatino, Bethany R; Whittemore, Jacqueline C.

doi:10.2460/javma.245.2.222

Cited by 8 publications

(20 citation statements)

References 13 publications

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“…6,18 However, an overdose may cause life-threatening consequences. [11][12][13][14] Cyclophosphamide can produce gastrointestinal toxicity (anorexia, diarrhea, vomiting), sterile haemorrhagic cystitis and myelosuppression. 1,3,18 Vincristine, on the other hand, can produce myelosuppression, gastrointestinal toxicity and less common peripheral neuropathy.…”

Section: Discussionmentioning

confidence: 99%

“…16,20 The side effects described in the veterinary literature are the same for the patients treated with a therapeutic dose and for those receiving an overdose, but the severity of them can vary when classified based on the Veterinary Cooperative Oncology Group criteria for adverse events (VCOG-CTCAE) version 2. 1,3,[11][12][13][14]18,21 Most cases described in the literature had a favourable outcome, although a fatal outcome despite supportive treatment has also been described in a dog. [11][12][13][14] Our patient meets the presentation previously described and no new adverse events were detected.…”

Section: Discussionmentioning

confidence: 99%

“…13,15 Therefore, in our patient we opted for classic management as described in the literature. [11][12][13][14][15] Neutropenia following chemotherapy administration is a well-characterised adverse event in both human and veterinary oncology. 6,15,24 As neutrophils are the main part of the innate immune response, any depletion in neutrophil count can predispose the patient to infections.…”

Section: Discussionmentioning

confidence: 99%

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Complete recovery of a cyclophosphamide overdose after vincristine administration in a dog

Ferrer‐Jorda¹,

Rodriguez‐Piza²

2023

Vet Record Case Reports

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A 4-year-old, entire, male boxer diagnosed with a T-cell multicentric lymphoma was referred for managing cyclophosphamide overdose complications after a prescription mistake during a 19-week WM-CHOP rescue protocol (vincristine, cyclophosphamide, doxorubicine, prednisolone). Adverse events included myelosuppression with grade IV neutropenia and thrombocytopenia, fever, haematuria, rectorrhagia and petechiae. With supportive care and the use of granulocyte-macrophage colony-stimulating factor, the patient recovered completely 23 days after the overdose. Once recovered, the protocol continued with doxorubicin as a single agent. The dog was euthanased due to lymphoma relapse without overdose sequelae. This case report describes for the first time, a recovery after cyclophosphamide intoxication produced immediately after the administration of vincristine in a cancer patient. Therefore, vincristine at therapeutic dose did not seem to add toxicity synergistically in this patient. Security strategies have to be put in place in all the centres to minimise the risk from these life-threatening accidents.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Complete recovery of a cyclophosphamide overdose after vincristine administration in a dog

Ferrer‐Jorda¹,

Rodriguez‐Piza²

2023

Vet Record Case Reports

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“…Chemotherapy OD rates in veterinary medicine are similarly unknown and current literature is based on individual case reports. Dog chemotherapy ODs have been reported with cyclophosphamide ( 16 , 17 ), 5-fluorouracil ( 18 ), lomustine ( 19 ), methotrexate ( 20 , 21 ), vincristine ( 22 ) and doxorubicin ( 23 ). Cat chemotherapy ODs have been reported with vinca alkaloids ( 24 , 25 ).…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Evaluation of Chemotherapy Overdoses in Dogs and Cats

et al. 2021

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Chemotherapy overdoses (ODs) are severe complications that can occur following the use of antineoplastics. However, little is known about chemotherapy ODs in veterinary medicine. The goals of this retrospective study were to report the occurrence, type, and cause of known chemotherapy ODs in companion animal medicine. The American College of Veterinary Internal Medicine oncology and internal medicine listservs were solicited for chemotherapy OD cases in dogs and cats. An OD was defined as administration of a chemotherapy dose 10% higher than intended, or at a shorter interval than planned. Twelve non-anthracycline ODs in 11 dogs, and 3 cat ODs, were collected. Overdoses in dogs included carboplatin, cyclophosphamide, L-asparaginase, lomustine, mustargen, vincristine, and vinorelbine. The cat ODs included doxorubicin and vincristine. In dogs, the median OD was 2.1x (range: 1.2–10x) the intended dose. All dogs survived the OD and developed a variety of gastrointestinal and hematologic toxicities of varying grades. Both cats with a 2.4x vincristine OD died despite supportive care. The cat who received a 2x OD of doxorubicin survived the event, experiencing Veterinary Cooperative Oncology Group–common terminology criteria for adverse events (VCOG) grade I thrombocytopenia and anemia, and VCOG grade II neutropenia. Chemotherapy ODs appear to be rare in veterinary medicine and are typically 2–3xs the intended dose. Clinical effects include VCOG grade I and II gastrointestinal distress and VCOG grade III and IV hematologic effects. With appropriate supportive care, most patients will survive the event. Life-threatening events are more common in cats following vincristine ODs.

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“… 1 Inaccurate chemotherapy administration also occurs in veterinary medicine, despite the adoption of similar safety protocols. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 Reports regarding the frequency and type of ODs are lacking in both human and veterinary medicine.…”

Section: Introductionmentioning

confidence: 99%

Toxicity, outcome, and management of anthracycline overdoses in 16 dogs

Lawson

Musser

Regan³

et al. 2021

Veterinary Internal Medicne

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Background Despite multiple reports of chemotherapy overdoses (ODs) in human and veterinary medicine, anthracycline ODs have been described infrequently. Hypothesis/Objectives Describe toxicities, treatments, and overall outcome after anthracycline OD in dogs. Animals Twelve mitoxantrone (MTX) and 4 doxorubicin (DOX) ODs were evaluated. Methods Multicenter retrospective analysis. The American College of Veterinary Internal Medicine oncology and internal medicine listservs were solicited for cases in which a chemotherapy OD occurred. Results Sixteen anthracycline cases were collected. Anthracycline ODs occurred because of an error in chemotherapy preparation (n = 9), or dose miscalculation (n = 7). The overall median OD was 1.9× (range, 1.4‐10×) the prescribed amount. Most ODs were identified immediately after drug administration (n = 11), and the majority of patients were hospitalized on supportive care (n = 11) for an average of 8 days (range, 3‐34 days). Adverse events after the OD included neutropenia (94%), thrombocytopenia (88%), anemia (63%), diarrhea (63%), anorexia (56%), vomiting (38%), lethargy (31%), and nausea (25%). Two patients did not survive the OD. High grade neutropenia was common and did not appear to be mitigated by the administration of filgrastim. Conclusions and Clinical Importance All patients received supportive care after identifying the OD and death was uncommon. Further evaluation is needed to determine ideal therapeutic guidelines anthracycline OD.

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Cyclophosphamide intoxication because of pharmacy error in two dogs

Cited by 8 publications

References 13 publications

Complete recovery of a cyclophosphamide overdose after vincristine administration in a dog

Complete recovery of a cyclophosphamide overdose after vincristine administration in a dog

A Retrospective Evaluation of Chemotherapy Overdoses in Dogs and Cats

Toxicity, outcome, and management of anthracycline overdoses in 16 dogs

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