Yüksek Doz Sitozin Arabinozid İlişkili Asemptomatik Bradikardi

Öz

Sitozin Arabinosid (Sitarabin), akut miyeloid lösemide (AML) yaygın olarak kullanılan ajanlardan biridir. Tedavi sırasında kardiyovasküler yan etkiler genellikle gözlenmez. Biz akut miyeloid lösemili bir hastada konsolidasyon tedavisi sırasında gelişen asemptomatik bradikardisi olan olguyu sunmayı amaçladık. 34 yaşındaki erkek hastaya Şubat ayında AML tanısı konuldu. İndüksiyon kemoterapisi sonrası konsolidasyon tedavisi için 2x1,5 gram/m² yüksek doz sitarabin tedavisine başlandı. Tedavinin 11. gününde (kemoterapi tedavisinin bitmesinden 6 gün sonra) nabzı 39 atım/dk'ya düştü. Yüksek doz sitozin arabinosid tedavisi başlandıktan sonraki 12. günde hastanın nabız sayısı 50/dk'nın üzerindeydi ve takip eden günlerde bradikardisi olmadı. Bradikardinin nedenlerinin diğer nedenleri dışlandı. Hastanın ejeksiyon fraksiyonunun %65 olduğu, sinüs bradikardisi olduğu ve kalp hızının ritmik olduğu saptandı. Literatürde akut miyeloid lösemili yedi hastada, akut lenfoblastik lösemili bir hastada, Hodgkin dışı lenfomalı bir hastada ve yüksek doz sitozin arabinozid ile ilişkili bradikardi bildiren Hodgkin lenfomalı bir hastada bradikardi saptanmıştır. Ayrıca akut miyeloid lösemili bir hastada düşük doz sitozin arabinosid ile bradikardi gelişti. Olgumuz literatürde sitarabin nedeniyle bradikardi gelişen 11. olgudur.

Anahtar Kelimeler

• akut myeloid lösemi
• kardiyovasküler yan etki
• bradikardi
• yüksek doz siterabin

High Dose Cytosine Arabinoside- Induced Asymptomatic Bradycardia

Öz

Cytosine Arabinoside (Cytarabine) is commonly used agents in acute myeloid leukemia (AML). Cardiovascular side effects are not common during treatment. We aimed to present asymptomatic bradycardia developed during the first consolidation treatment in a patient with acute myeloid leukemia. A 34-year-old male patient was diagnosed with AML in February. After induction chemotherapy, high dose cytarabine treatment was started at 2x1.5 grams/m² for consolidation treatment. On the 11th day of the treatment, his pulse decreased to 39 beats/min. On the 12th day after the initiation of high dose cytosine arabinoside treatment (6 days after chemotherapy treatment ends), the patient's pulse rate was above 50/min, and there was no bradycardia in the following days. Other causes of other causes of bradycardia were excluded. It was reported that the patient had sinus bradycardia with an ejection fraction of 65% and his heart rate was rhythmic. There are seven patients with acute myeloid leukemia, one patient with acute lymphoblastic leukemia, one patient with non-Hodgkin's lymphoma, and one patient with Hodgkin's lymphoma who reported high dose cytosine arabinoside associated bradycardia. In addition, one patient with acute myeloid leukemia developed bradycardia with low dose cytosine arabinoside. Our case is the 11th case in the literature that develops bradycardia due to cytarabine.

Anahtar Kelimeler

• cardiovascular side effect
• acute myeloid leukemia
• bradycardia
• high dose cytarabine
• side effect.

Kaynakça

1. 1. Chabner BA, Branes J, Cleary J, et al. Pharmacology and toxicity of antineoplastic drugs. In: Kaushansky K, Lichtman MA, Beutler E, et al ed. Williams Hematology. 8. New York, NY: Mc Graw-Hill; 2010.p.288-9
2. 1. Chabner BA, Branes J, Cleary J, et al. Pharmacology and toxicity of antineoplastic drugs. In: Kaushansky K, Lichtman MA, Beutler E, et al ed. Williams Hematology. 8. New York, NY: Mc Graw-Hill; 2010.p.288-9
3. 2. Kumar S, Noronha V, Chu E. Pharmacology of cancer chemotherapy. In: DeVita V Jr, Hellman S, Rosenberg SA, editors. Cancer: principles and practice of oncology. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2005366.
4. 2. Kumar S, Noronha V, Chu E. Pharmacology of cancer chemotherapy. In: DeVita V Jr, Hellman S, Rosenberg SA, editors. Cancer: principles and practice of oncology. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2005366.
5. 3. Cil T, Kaplan AM, Altintas A, et al. Cytosine-arabinoside induced bradycardia in patient with non-Hodgkin lymphoma: a case report. Leuk Lymphoma 2007; 48: 1247–49.
6. 3. Cil T, Kaplan AM, Altintas A, et al. Cytosine-arabinoside induced bradycardia in patient with non-Hodgkin lymphoma: a case report. Leuk Lymphoma 2007; 48: 1247–49.
7. 4. Romani C, Pettinau M, Murru R, et al. Sinusal bradycardia after receiving intermediate or high dose cytarabine: four cases from a single institution. Eur J Cancer Care (Engl) 2009; 18: 320–21.
8. 4. Romani C, Pettinau M, Murru R, et al. Sinusal bradycardia after receiving intermediate or high dose cytarabine: four cases from a single institution. Eur J Cancer Care (Engl) 2009; 18: 320–21.

9. 5. Stamatopoulos K, Kanellopoulou G, Vaiopoulos G, et al. Evidence for sinoatrial blockade associated with high dose cytarabine therapy. Leuk Res 1998; 22: 759–61.
10. 5. Stamatopoulos K, Kanellopoulou G, Vaiopoulos G, et al. Evidence for sinoatrial blockade associated with high dose cytarabine therapy. Leuk Res 1998; 22: 759–61.
11. 6. Kumagawa M, Suzuki K, Nagano M, et al. High dose ara-C therapy induced bradycardia in an acute myeloid leukemia patient with inv (16)(p13q22). Rinsho Ketsueki 2003; 44: 404–06.
12. 6. Kumagawa M, Suzuki K, Nagano M, et al. High dose ara-C therapy induced bradycardia in an acute myeloid leukemia patient with inv (16)(p13q22). Rinsho Ketsueki 2003; 44: 404–06.
13. 7. Wayangankar SA, Patel BC, Parekh HD, et al. High-dose cytosine arabinoside-induced symptomatic bradycardia Journal of Cardiovascular Medicine 2015; 16: 38-41.
14. 7. Wayangankar SA, Patel BC, Parekh HD, et al. High-dose cytosine arabinoside-induced symptomatic bradycardia Journal of Cardiovascular Medicine 2015; 16: 38-41.
15. 8. Teke Hava Üsküdar, Karagülle Mustafa, Akay Olga Meltem. High dose cytosine arabinoside induced sinus bradycardia in a Hodgkin`s lymphoma patient The Anatolian Journal of Cardiology 2013; 13: 618-19.
16. 8. Teke Hava Üsküdar, Karagülle Mustafa, Akay Olga Meltem. High dose cytosine arabinoside induced sinus bradycardia in a Hodgkin`s lymphoma patient The Anatolian Journal of Cardiology 2013; 13: 618-19.
17. 9. Erdem F, Bilen Y, Çadirci K, et al. Low-dose cytosine arabinoside-induced symptomatic bradycardia in a patient with acute myeloid leukemia. J Cardiol Cases 2013; 8: 105-07.
18. 9. Erdem F, Bilen Y, Çadirci K, et al. Low-dose cytosine arabinoside-induced symptomatic bradycardia in a patient with acute myeloid leukemia. J Cardiol Cases 2013; 8: 105-07.
19. 10. Albsheer K, Fadul A, Khalafalla A, Abdalla EM, Al-Dubai H. Cytarabine-Induced Bradycardia: A Case Report. Cureus. 2022 Oct 24;14(10):e30624.
20. 10. Albsheer K, Fadul A, Khalafalla A, Abdalla EM, Al-Dubai H. Cytarabine-Induced Bradycardia: A Case Report. Cureus. 2022 Oct 24;14(10):e30624.