Vincristine-induced myocardial infarction

Abstract

A patient with lymphosarcoma treated with weekly injections of vincristine developed an acute myocardial infarction immediately after the second injection of vincristine. After he recovered from the infarction, the treatment was continued and he developed an additional myocardial infarction. I n vivo and in vitro studies have not revealed any effect of vincristine on the clotting mechanism. T h e possible causes for the association of vincristine-treated lymphoma and myocardial infarction are discussed.Cancer 36:1979-1982, 1975. H E TOXIC EFFECT OF VINCRISTINE IS MAINLYT neurologic,4 manifesting as muscle weakness, paresthesia, loss of deep tendon reflexes, ptosis, diplopia, a n d hoarseness. Alopecia a n d constipation commonly occur. O t h e r rare side effects are inappropriate ADH secretion9 orthostatic hypotension,z a n d thrombocytosis.8To the best of o u r knowledge, myocardial infarction has n o t been mentioned i n t h e literature as a complication of vincristine administration.In this study we describe n case of myocardial infarction which developed i n a patient with lymphosarcoma after vincristine administration. CASE REPORTF.Z., a 58-year-old male originating from Rumania, was admitted to the Department because of lymphadenopathy and weakness of 1 month's duration. Two years previously, he had suffered a myocardial infarction and since then from mild angina pectoris. On physical examination the patient was found to be in good general condition, weighing 76 kg. He had no fever. Enlarged lymph T h e authors thank Miss van-der-Lyjn for her excellent technical assistance.Received for publication March 25. 1975. nodes, u p to 2 cm in diameter, firm, nontender, and nonadherent to skin were palpated in the neck and inguinal areas. T h e spleen and liver were not palpable. All laboratory findings, including complete blood count, renal and liver function tests were within normal limits. Electrocardiogram (ECG) on admission showed an absence of R waves in leads V, V, and Q wave in leads L,, aVF ( Fig. 1). A lymph node was hiopsied and the diagnosis of lymphosarcoma was established.Treatment with weekly injections of vincristine, according to an increasing dose schedule, was started. T h e first weekly injection of 3.8 mg was tolerated well. One hour after the second intravenous injection of 7.6 mg vincristine (0.1 mg/kg body weight) the patient complained of severe pressing precordial pain radiating to the left arm which lasted for 2 hours. His blood pressure was 130/80 mm mercury, the pulse rate 100 per minute with occasional extrasystoles. An ECG recording revealed T wave inversion in leads L, L,, aVL, V,V,, S T depression in V,-V,, S T elevation in L,, and premature ventricular contractions (Fig. 2).Examination of blood enzyme levels showed serum creatin phosphokinase (CPK) 5.0 Menashe-Gaist units (normal 0.9-3.0 units), lactic dehydrogenase (LDH) 476 King units (normal 100-250 units), and serum glutamic oxnloacetic transaminase (SGOT) 28 Sigms units (normal 15-40 units).T h e possibility of a vincrist...

Cumulative anthracycline exposure and risk of cardiotoxicity; a Danish nationwide cohort study of 2440 lymphoma patients treated with or without anthracyclines

“…Series that compare incidental cardiac disease in lymphoma patients treated with anthracyclines to the similar risk in a matched background population could potentially overestimate the cardiotoxic effects of anthracyclines because lymphoma in general, as well as surveillance bias arising from being frequently consulted by physicians, may be associated with cardiotoxicity and increased likelihood of being diagnosed with CVD. Of note, other drugs included in the R‐CHOP regimen such as rituximab, cyclophosphamide and vincristine, have been causally linked to cardiotoxicity (Mandel et al , ; Mills & Roberts, ; Gottdiener et al , ; Goldberg et al , ; Foran et al , ; Renard et al , ). In this Danish nationwide study, we examined the risk of cardiac disease (CHF and CVD) in a cohort of patients with DLBCL or follicular lymphoma (FL) treated with immunochemotherapy with or without anthracyclines in first‐line.…”

Rituximab-Vincristine Chemotherapy-Induced Acute Anterior Wall Myocardial Infarction with Cardiogenic Shock

“…2,6,7 A study by Mikaelian and colleagues 8 showed that tubulin-binding drugs (including vincristine and vinblastine) can induce cell-cycle arrest of the rapidly proliferating cardiac endothelial cells and cause myocardial infarction. Vincristine is more often reported to cause ischemic syndromes than is rituximab, but a catastrophic synergism of vincristine and rituximab certainly cannot be ruled out.…”

Treatment of cardiovascular diseases in cancer patients

“…Likewise complications have been reported with capecitabine, an orally administered prodrug of 5-FU [15]. Furthermore, coronary vasospasm and myocardial ischemia have been linked to vinca alkaloids (e.g., vincristine, vinblastine) [16,17].…”