Inadvertent overdose with lomustine (CCNU) followed by hematologic recovery

Foon, K.A.; Haskell, C.M.

Cancer Treatment Reports 66(5): 1241-1242


ISSN/ISBN: 0361-5960
PMID: 7083228
Document Number: 5412
Hematopoietic toxicity is the dose-limiting factor in cancer therapy with lomustine (CCNU). Due to its prolonged myelotoxicity, therapy is generally limited to a dosage of 100-130 mg/m2 every 6-8 weeks. A correlation between the severity of leukopenia and thrombocytopenia and tumor response has been demonstrated for lomustine, suggesting that a beneficial tumoricidal effect might be obtained with megadose lomustine. One approach to this problem might be infusing autologous bone marrow after highdose lomustine. A patient with colorectal carcinoma metastatic to the liver and lung was treated with lomustine. Over the course of 1 week, he mistakenly took a prescription intended for use during four cycles. The total dose was 1120 mg (12.5 mg/kg, or 550 mg/m2). The patient developed severe bone marrow aplasia. With supportive therapy, but without the benefit of autologous marrow infusion, his bone marrow recovered. There was no objective reduction in the size of his tumor.

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Inadvertent overdose with lomustine (CCNU) followed by hematologic recovery