采用含博来霉素ABVD方案治疗霍奇金淋巴瘤合并肺结核致患者死亡1例

Bleomycin-induced Death Following ABVD Chemotherapy for Hodgkin’s Disease with Pulmonary Tuberculosis

关键词:  霍奇金淋巴瘤  肺结核  博来霉素  死亡  不良反应

Key words:  Hodgkin’s disease  pulmonary tuberculosis  bleomycin  death  adverse reation

摘要:

目的 ABVD化疗方案中博来霉素治疗指数较低，本文报道1例死亡病例供临床参考，旨在提示临床谨慎应用。方法 报道1名74岁的中国男性患者因发热、咳嗽入院，经诊断为经典霍奇金淋巴瘤合并肺结核。采用ABVD化疗方案，第1天给予多柔比星35 mg，长春地辛4 mg，达卡巴嗪500 mg，博来霉素15 mg。结果 患者给予博来霉素20 min后，体温突然升至41 ℃并伴有呼吸困难、多汗、昏迷症状，血压下降至108/58 mmHg，患者最后死于多器官功能衰竭。结论 对于合并肺结核的老年霍奇金病患者特别是年龄>70岁者，应该谨慎选择含有博来霉素的化疗方案。并且在充分给予预防用药后，首先使用1 mg 的博来霉素进行预实验，如果没有不良反应发生才能全剂量给药。

Abstract:

OBJECTIVE Bleomycin (BLM) in ABVD regimen has a low therapeutic index. BLM-induced Death which we reported suggested that we should be cautious to use it. METHODS It was reported a 74-year-old Chinese man admitted to our hospital for fever, cough was diagnosed with classical Hodgkin’s disease with pulmonary tuberculosis. Doxorubicin, 35mg i.v., vinblastine, 4 mg i.v., dacarbazine 500 mg i.v., and BLM 15 mg i.v. were injected on the first day. RESULTS Twenty minutes after the BLM injection, the patient spiked a temperature to 41.0 ℃ with concomitant symptoms of dyspnea, hyperhidrosis and coma, and blood pressure dropped to 108/58 mmHg. The patient finally succumbed to multiple organ failure caused by BLM-induced toxicity. CONCLISION Chemotherapy regimen including BLM should be cautiously selected for the patients, especially patients >70 years old with pulmonary complication. It should be recommended that the empirical 1 unit test dose is administered after prophylactic agents. If no acute reaction occurs, recommended dosage regimen may then be administered.