Azacitidine-associated pleuropericardial effusion in myelodysplastic syndrome: A case report

Abstract

Azacitidine, a deoxyribonucleic acid hypomethylating agent, is used in the treatment of myelodysplastic syndrome. Common adverse effects of azacitidine include bone marrow suppression, injection site reactions, nausea, vomiting, diarrhea, and fatigue. This report focuses on pleuropericardial effusions, an infrequently reported and potentially reversible adverse effect of azacitidine. In this case report, pleuropericardial effusion manifested as the sole radiographic finding in the evaluation of cough occurring during the eighth cycle of treatment with azacitidine. Symptoms and radiographic abnormalities resolved with corticosteroids and diuretics, and the patient could continue with therapy.

Keywords

Myelodysplastic syndrome azacitidine hypomethylating agent pleural effusion pericardial effusion

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References

American Cancer Society. What are myelodysplastic syndromes? www.cancer.org/cancer/myelodysplastic-syndrome/about/what-is-mds.html (2015, accessed 8 December 2017).

Cogle

Craig

Rollison

et al.

Incidence of the myelodysplastic syndromes using a novel claims-based algorithm: high number of uncaptured cases by cancer registries. Blood 2011; 117: 7121–7125.

Aul

Giagounidis

Germing

. Epidemiological features of myelodysplastic syndromes: results from regional cancer surveys and hospital-based statistics. Int J Hematol 2001; 73: 405–410.

. Epidemiology of myelodysplastic syndromes. Am J Med 2012; 125: S2–S5.

American Cancer Society. What are the key statistics about myelodysplastic syndromes? www.cancer.org/cancer/myelodysplastic-syndrome/about/key-statistics.html (2015, accessed 8 December 2017).

Greenberg

Tuechler

Schanz

et al.

Revised international prognostic scoring system for myelodysplastic syndromes. Blood 2012; 120: 2454–2465.

Fenaux

Mufti

Hellstrom-Lindberg

et al.

Efficacy of azacitidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: a randomized, open-label, phase III study. Lancet Oncol 2009; 10: 223–232.

Silverman

Demakos

Peterson

et al.

Randomized controlled trial of azacitidine in patients with the myelodysplastic syndrome: a study of the cancer and leukemia group B. J Clin Oncol 2002; 20: 2429–2440.

Christman

. 5-Azacytidine and 5-aza-2′-deoxycytidine as inhibitors of DNA methylation: mechanistic studies and their implications for cancer therapy. Oncogene 2002; 21: 5483–5495.

10.

Derissen

Beijnen

Schellens

. Concise drug review: azacitidine and decitabine. Oncologist 2013; 18: 619–624.

11.

Stresemann

Lyko

. Modes of action of the DNA methyltransferase inhibitors azacitidine and decitabine. Int J Cancer 2008; 123: 8–13.

12.

Celgene Corporation. Vidaza (package insert). Summit, NJ: Celgene Corporation, 2016.

13.

U.S. Food and Drug Administration. FDA adverse events reporting system (FAERS) public dashboard, https://fis.fda.gov/sense/app/777e9f4d-0cf8-448e-8068-f564c31baa25/sheet/45beeb74-30ab-46be-8267-5756582633b4/state/analysis (2018, accessed 20 May 2018).

14.

Ganipisetti

Akhtari

. 190 Azacitidine causing pleuropericardial effusions. Should the treatment be continued or not? Leuk Res 2015; 39: S95–S95.

15.

Laufer

Roberts

. Differentiation syndrome in acute myeloid leukemia after treatment with azacitidine. Eur J Haematol 2005; 95: 484–485.

16.

Misra

Gabriel

Nacoulma

et al.

How to diagnose early 5-azacytidine-induced pneumonitis: a case report. Drug Saf 2017; 4: 4–4.

17.

Tefferi

Vardiman

. Myelodysplastic syndromes. N Engl J Med 2009; 361: 1872–1885.

18.

Esteller

. Epigenetics in cancer. N Engl J Med 2008; 358: 1148–1159.

19.

Samiev

Chatt

Armimtage

et al.

A primary care approach to myelodysplastic syndromes. Korean J Fam Med 2014; 35: 111–118.

20.

Silverman

Fenaux

Mufti

et al.

Continued azacitidine therapy beyond time of first response improves quality of response in patients with higher-risk myelodysplastic syndromes. Cancer 2011; 117: 2697–2702.

21.

Wells

Leber

Zhu

et al.

Optimizing outcomes with azacitidine: recommendations from Canadian centers of excellence. Curr Oncol 2014; 21: 44–50.

22.

Voso

Breccia

Lunghi

et al.

Rapid loss of response after withdrawal of treatment with azacitidine: a case series in patients with higher-risk myelodysplastic syndromes or chronic myelomonocytic leukemia. Eur J Haematol 2013; 90: 345–348.

23.

Sampat

Rossi

Garcia-Gutierrez et al.

Characteristics of pericardial effusions in patients with leukemia. Cancer 2010; 116: 10–10.

24.

Imazo

Adler

. Management of pericardial effusion. Eur Heart J 2013; 34: 1186–1197.

25.

Karkhanis

Joshi

. Pleural effusion: diagnosis, treatment, and management. Open Access Emerg Med 2012; 4: 31–52.

26.

Sagrista-Sauleda

Merce

Soler-Soler

. Diagnosis and management of pericardial effusion. World J Cardiol 2011; 3: 135–143.

27.

Newman

Malla

Gojo

. Azacitidine-induced pericarditis: a case series. Pharmacotherapy 2016; 36: 443–448.

28.

Chen

You

et al.

Decitabine-induced effusions. Leuk Res 2009; 33: e150–e151.

29.

Naranjo

Busto

Sellers

et al.

A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30: 239–245.