Rare Respiratory and Neurologic Adverse Reactions to Azacitidine in the Treatment of Myelodysplastic Syndrome of Patients Treated at the Ottawa Hospital

Ahrari, Azin; Sabloff, Mitchell; Bredeson, Chris; Pakhalé, Smita; Souza, Carolina A.; Zwicker, Jocelyn; Sheppard, Dawn

doi:10.14740/jh227w

Cited by 4 publications

(5 citation statements)

References 20 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients tend to improve significantly after steroid treatment [11][12][13]. In the reported cases in which patients were later rechallenged with azacitidine, they then presented with recurrent, more severe respiratory symptoms [10,[13][14].…”

Section: Discussionmentioning

confidence: 98%

Azacitidine-Induced Pneumonitis in a Patient With Acute Myeloid Leukemia and Hyperleukocytosis

Litvin¹,

Dasgupta²,

Eldin³

et al. 2022

Cureus

View full text Add to dashboard Cite

Chemotherapy-related toxicity is a complex aspect of oncologic care. Pulmonary toxicity, in particular, poses a significant challenge, as it can have diverse presentations and can closely mimic other common complications of cancer treatment, such as infections. Azacitidine is an agent widely employed in high-risk myelodysplastic syndrome and acute myeloid leukemia. We present a case of azacitidine-induced pneumonitis, a rare adverse effect, in a 70-year-old patient with acute myeloid leukemia (AML) and hyperleukocytosis. After discontinuation of the drug and introduction of steroids, the patient had complete resolution of symptoms, highlighting the importance of identifying and addressing chemotherapy-induced pneumonitis.

show abstract

Section: Discussionmentioning

confidence: 98%

Azacitidine-Induced Pneumonitis in a Patient With Acute Myeloid Leukemia and Hyperleukocytosis

Litvin¹,

Dasgupta²,

Eldin³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…**In cases with eosinophilic pneumonia resulting from azacitidine-induced lung injury, changes are usually seen in a peripheral distribution in the middle and upper lung zones.4 (4) Pleural effusion was seen in some cases (30,37). ***Pleural fluid analysis described in the literature was extremely variable.3 (3) Bronchoscopy and bronchoalveolar lavage (BAL) fluid analysis is usually suggestive of active, non-infectious inflammatory conditions, with predominant lymphocytosis and, in some cases, eosinophilia with no identified pathogens (4,28,37,87). ****Lung biopsy can greatly help distinguish azacitidine-induced lung injury from other causes, especially infections.…”

Section: Discussionmentioning

confidence: 99%

“…Toxicity from azacitidine is irrelevant to its cumulative dose (46). Most cases occurred after eight weeks of initiation, i.e., the second cycle of azacitidine, but others have been widely inconstant (4,10,37,38,47,48). The severity of lung injury is highly variable, but in most cases, the longer it takes to recognize it and start steroids, the higher the risk of serious complications, including mortality (49).…”

Section: Azacitidine-induced Lung Toxicitymentioning

confidence: 99%

See 1 more Smart Citation

Azacitidine induced lung injury: report and contemporary discussion on diagnosis and management

Alyamany,

Alnughmush,

Almutlaq

et al. 2024

Front. Oncol.

View full text Add to dashboard Cite

Azacitidine, a hypomethylating agent, has caused a paradigm shift in the outcomes of patients with myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) who are not eligible for stem cell transplantation, particularly in combination with BCL2 and IDH inhibitors. Azacitidine and Azacitidine-based combinations have been widely considered a safe low-intensity therapy when compared to traditional conventional treatments. The development of lung toxicity from azacitidine is not a well-characterized adverse event. However, if it happens, it can be fatal, especially if not recognized and treated promptly. In this review, we aim to familiarize the reader with the presentation of azacitidine-induced lung injury, provide our suggested approach to management based on our experience and the current understanding of its mechanism, and review the literature of 20 case reports available on this topic.

show abstract

“…Corticotherapy 0.75 mg/kg per day + oxygen therapy Recovered No Patel et al 2015; USA [ 12 ] MDS M 74 Fever, cough, shortness of breath 2 days after 2nd cycle Chest radiograph and tomography: bilateral interstitial infiltrates and ground-glass opacities Cultures negative BAL inflammatory 1. Corticosteroids Recovered NA Ahrari et al 2015; Canada [ 13 ] MDS M 73 Fever, chills, night sweats Start of 3rd cycle Blood culture: Mycobacterium fortuitum Chest radiograph: bilateral hilar enlargement and bilateral perihilar ground-glass opacities Chest tomography: bilateral ground-glass opacities with reticulation in the mid- and upper lung zones and patchy peripheral airspace consolidation BAL negative 1. Levofloxacin 2.…”

Section: Discussionmentioning

confidence: 99%

How to Diagnose Early 5-Azacytidine-Induced Pneumonitis: A Case Report

Misra

Gabriël

Nacoulma

et al. 2017

Drug Saf - Case Rep

View full text Add to dashboard Cite

Interstitial pneumonitis is a classical complication of many drugs. Pulmonary toxicity due to 5-azacytidine, a deoxyribonucleic acid methyltransferase inhibitor and cytotoxic drug, has rarely been reported. We report a 67-year-old female myelodysplastic syndrome patient treated with 5-azacytidine at the conventional dosage of 75 mg/m2 for 7 days. One week after starting she developed moderate fever along with dry cough and subsequently her temperature rose to 39.5 °C. She was placed under broad-spectrum antibiotics based on the protocol for febrile neutropenia, including ciprofloxacin 750 mg twice daily, ceftazidime 1 g three times daily (tid), and sulfamethoxazole/trimethoprim 400 mg/80 mg tid. High-resolution computed tomography of the chest disclosed diffuse bilateral opacities with ground-glass shadowing and pleural effusion bilaterally. Mediastinal and hilar lymph nodes were moderately enlarged. polymerase chain reaction for Mycobacterium tuberculosis, Pneumocystis jiroveci, and cytomegalovirus were negative. Cultures including viral and fungal were all negative. A diagnosis of drug-induced pneumonitis was considered and, given the negative bronchoalveolar lavage in terms of an infection, corticosteroid therapy was given at a dose of 1 mg/kg body weight. Within 4 weeks, the patient became afebrile and was discharged from hospital. Development of symptoms with respect to drug administration, unexplained fever, negative workup for an infection, and marked response to corticosteroid therapy were found in our case. An explanation could be a delayed type of hypersensitivity (type IV) with activation of CD8 T cell which could possibly explain most of the symptoms. We have developed a decision algorithm in order to anticipate timely diagnosis of 5-azacitidine-induced pneumonitis, and with the aim to limit antibiotics abuse and to set up emergency treatment.

show abstract

Rare Respiratory and Neurologic Adverse Reactions to Azacitidine in the Treatment of Myelodysplastic Syndrome of Patients Treated at the Ottawa Hospital

Cited by 4 publications

References 20 publications

Azacitidine-Induced Pneumonitis in a Patient With Acute Myeloid Leukemia and Hyperleukocytosis

Azacitidine-Induced Pneumonitis in a Patient With Acute Myeloid Leukemia and Hyperleukocytosis

Azacitidine induced lung injury: report and contemporary discussion on diagnosis and management

How to Diagnose Early 5-Azacytidine-Induced Pneumonitis: A Case Report

Contact Info

Product

Resources

About