A 3-year-old girl with multiple site bone involvement but normal lung, liver and bone marrow, is receiving chemotherapy since one year ago including vinblastine every three months, prednisolone, 6-MP, and MTX. She has responded very well, but developed polyuria and polydipsia consistent with DI. Her MRI of hypophysis is normal. Is it necessary to intensify or change her chemotherapy protocol, and if so, what is your suggestions?
I am assuming the patient is receiving induction therapy at this point. Where are you at with your treatment. I am assuming your paient is on DDAVP. Patients with DI are typically show in MRI scans a loss of the posterior bright spot of the pituitary gland or thickening of the pituitary stalk. Did you have an initial PET scan in your patient. Did the brain MRI exclude mass lesions in the white or grey matter. The patient does not have any evdeince of neurodegenerative disorder, correct ? I am assuming you are using Prednisolone (40 mg/m2/day orally on days 1 through 5), repeated every three weeks Vinblastine (6 mg/m2 intravenously on day 1), repeated every three weeks. As you know, it is very important that a CNS disease is carefully ruled out as you would need to use therapy directed at the CNS disease if there is one. (Example: Cladribine: Dhall G, Finlay JL, Dunkel IJ, et al. Analysis of outcome for patients with mass lesions of the central nervous system due to Langerhans cell histiocytosis treated with 2-chlorodeoxyadenosine. Pediatr Blood Cancer 2008; 50:72.)
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