Cytostatic illness — a complex of the syndromes developing at use of intensive cytostatic care, caused by its toxic influence on various phases of a cellular cycle.
Epidemiology The cytostatic illness often meets in oncohematological practice as the aspiration to gain necessary medical effect is followed by various collateral manifestations caused by toxic influence of the used antineoplastic himiopreparat.
Etiology and pathogeny Expressiveness of a cytostatic illness depends on a number of circumstances, generally on a dose of the applied means, duration of treatment, ways of their introduction and sensitivity of various cells of an organism to their toxic action (for example, Vincristinum most damages a peripheral nervous system, Cyclophosphanum — an epithelium of a digestive tract and skin, anthracyclines — a myocardium etc.).
All himiopreparata affect mainly the sharing cells owing to what arise miyelodepressivny, dispepsichesky, hepatic, immunodepressive and other syndromes.
There is a tropnost of drugs to this or that cellular line. Vincristinum toxic influences on granulotsito-and a monocytopoiesis, Dopanum, leukeranum, Degranolum, vinblastine, Natulanum and Cyclophosphanum — a lymphocytopoiesis; sarcolysine, Amethopterinum, 6 Mercaptopurinum, Cytarabinum and daunomitsin to the same extent suppress granulo-and a lymphocytopoiesis. Possess thrombocytopenic action miyelobromol, Bruneomycinum, rubomitsin.
Vincristinum and rubomitsin give myelotoxic effect in 4 — 7 days and its duration makes from 7 to 10 days, limfotoksichesky action of Natulanum is shown only in 25 — 36 days after the beginning of therapy and 2 — 3 weeks can remain.
Definition of a state can be considered as factors of increase of risk of development of a cytostatic illness. So, disturbance of zhelchevydelitelny function of a liver leads to accumulation in plasma of the himiopreparat allocated with bile; at a renal failure concentration in blood of drugs and their metabolites owing to their broken removal with urine increases; the cachexia is followed by increase of a catabolism and disturbance of exchange processes.
Classification On expressiveness of a combination of various clinical syndromes of a cytostatic illness allocate easy, average and heavy its forms.
Approximate formulation of the diagnosis: The cytostatic illness at an acute miyeloblastny leukosis owing to use of modern programs of polychemotherapy which was complicated by pneumonia and sepsis.
Clinic In the table the characteristic of clinical syndromes of a cytostatic illness is provided. At a combination of myelotoxic, dispepsichesky and immunodepressive syndromes danger to life of the patient increases. In development of a cytostatic illness the organospetsifichnost of cytostatic means matters. So, as a result of hepatotropic action of himiopreparat (L-asparaginase, a methotrexate, 6 Mercaptopurinum, Cytarabinum, Myelosanum) there can be disturbances from the fast-taking place functional frustration to toksiko-allergic hepatitis with the phenomena of a liver failure. Cardiotoxicity can be caused by antineoplastic antibiotics of group of anthracyclines, Vincristinum possesses a neurotoxicity.
Leukocytes ≥0,5*109/l, myelocariocytes ≥10*109/l, marrow it is poor in yadrosoderzhashchy elements
Leukocytes ≥0,05*109/l. myelocariocytes ≥3*109/l, marrow it is extremely poor in yadrosoderzhashchy elements, fatty tissue prevails
Nausea, erythema of mucous membranes of an oral cavity, hepatic tests normal
Nausea, incidental vomiting, single ulcers in an oral cavity, the passing diarrhea, intestinal microflora disturbance, a thymol turbidity test of ≥10 units, bilirubin of ≥40 µmol/l, aminotransferase of 300 g/l
Pernicious vomiting, ulcer and necrotic stomatitis, colitis, diarrhea (more than 10) times a day), a thymol turbidity test of ≥15 units, bilirubin of ≥40 µmol/l, aminotransferase of 500 g/l
Moderate tachycardia at an exercise stress
Tachycardia to 100 ud. in 1 min. at rest; single extrasystoles, vascular dystonia
Tachycardia at rest 100 ud. in 1 Mia, a miogofokusny ekstrasistoliya, blockade, vascular insufficiency
Urea of ≥9 mmol/l, proteinuria
Cystitis, leukocyturia; urea of ≥12 mmol/l, proterinuriya, urate nephropathy
Hemorrhagic cystitis, leukocyturia, urea of ≥20 mmol/l, proteinuria, oliguria
Vigilance, insignificant decrease in tendon jerks
Drowsiness, decrease in tendon jerks, meningism (headache, nausea, t of 38 °C), paresthesias
Sharp drowsiness up to a coma, lack of tendon jerks, sharply expressed meningism (severe headaches, vomiting, a photophobia, t of 39 °C), paresthesias, paresis up to paralysis
Reversible alopecia, skin peeling, formation of vesicles, itch
Irreversible alopecia, necroses, dermatitis
The localized infections
Heavy extensive infectious and inflammatory complications
Heavy it is purulent - necrotic processes, sepsis
Verification of the diagnosis The cytostatic illness is diagnosed on the basis of a complex of characteristic syndromes.
Treatment of a cytostatic illness
In therapy of a miyelodepressivny syndrome at a cytostatic illness the main place belongs to haemo component therapy.
The Dispepsichesky syndrome demands active disintoxication treatment, correction of a water salt metabolism. The enveloping and adsorbing means (white clay, Almagel, Enterodesum), the astringents (broths of a St. John's Wort, a camomile, oak bark, bismuth drugs), the antiseptic and antibacterial drugs, means normalizing flora of a digestive tract, influencing a peristaltics (cerucal), fermental drugs are applied (panzinorm, festal, digestal). In hard cases temporarily resort to parenteral food. In cases when ulcer and necrotic damage of a mucous membrane of a digestive tract is complicated by perforation, there can be a question of surgical intervention.
At the expressed abnormal liver functions cancel antileukemic means and appoint active gepatozashchitny therapy (5% glucose solution, Haemodesum, Prednisolonum, a diet); at disturbances of belkovoobrazovatelny function transfusions of albumine, a plasma concentrate are shown. Beneficial effect is exerted by hyperbaric oxygenation.
Cardiotoxic influence of cytostatic drugs demands their cancellation and the corresponding cardiological correction against disintoxication therapy and the rational mode. At nephrotoxic complications intravenous administrations and appointment in neutral and subacidic liquids, a diet, use of the uroseptic and removing uric acid drugs are shown (Allopyrinolum).
At infectious and infectious and necrotic processes the combination of antibiotics of a broad spectrum of activity and immune drugs (immunoglobulins, immune plasm) is used. At development of viral infections — antiviral drugs (zaveraks); at fungal — antifungal means (Amphotericinum In, nystatin).
At skin infections use antiseptic, antibacterial, immune drugs, surgical treatment of wounds. Toxic defeats of a nervous system will most difficult respond to treatment.