mesna and Leukemia

This article gives highlights of ongoing pediatric solid tumor and leukemia trials in the United States that use ifosfamide in combination with mesna. These trials are being carried out both by large cooperative groups and single institutions. Some role for ifosfamide with mesna in the front-line treatment of sarcomas is assured. Neurotoxicity, nephrotoxicity, and other unusual toxicities are discussed.

Topics: Antineoplastic Agents; Antineoplastic Agents, Alkylating; Antineoplastic Combined Chemotherapy Protocols; Child; Clinical Trials as Topic; Humans; Ifosfamide; Leukemia; Mesna; Multicenter Studies as Topic; Neoplasms; Sarcoma; United States

Haemorrhagic cystitis (HC) is an uncommon but potentially devastating complication of chemotherapy and bone marrow transplantation in children. We aimed to test the hypothesis that early recognition, sodium pentosan polysulfate (SPP), and avoidance of urethral catheterisation improve outcomes in children with HC.. A retrospective case note review was performed of all patients treated for HC in our hospital from 2002 to 2010. A protocol for the management of HC was introduced in 2007 advocating early detection, use of SPP, and avoidance of urethral catheterisation. Data collected on each patient included primary condition, medications at onset, blood transfusions, duration of symptoms, catheter usage, and outcome. Statistical analysis was performed using the Mann-Whitney U test, and Fisher's Exact test as appropriate, P < .05 being significant.. Five patients were treated using protocol with 5 historical controls. There was no significant difference between the ages of the group, diagnosis, and treatment at onset of HC. In the historical group, 4 of 5 died with HC, but all recovered in the protocol group (P < .05). Blood transfusion requirements were also significantly reduced after protocol introduction (P < .05).. Early identification, avoidance of urethral catheterisation, and use of SPP significantly reduces blood transfusion requirements and mortality from HC.

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; BK Virus; Child; Combined Modality Therapy; Cyclophosphamide; Cystitis; Fanconi Anemia; Female; Hematopoietic Stem Cell Transplantation; Hematuria; Herpesviridae Infections; Humans; Immunocompromised Host; Leukemia; Male; Mesna; Pentosan Sulfuric Polyester; Polyomavirus Infections; Postoperative Complications; Prospective Studies; Ultrasonography; Urinary Catheterization

Preventive effects of hemorrhagic cystitis by the use of sodium 2-mercaptoethane sulfonate (MESNA) was evaluated in 40 children undergoing peripheral blood stem cell autografts (PBSCT) after marrow-ablative chemotherapy which included high-dose cyclophosphamide (CY, 50mg/kg x 2). Fifteen patients received MESNA (group A) and 25 did not (group B), and all received concomitant hyperhydration (3,000ml/m2/day). No renal dysfunction or toxicity attributed to the use of MESNA was observed in either group of patients. Transient hemorrhagic cystitis developed in one of the 15 group A (6.7%) and 3 of 25 (12.0%) group B patients but there was no statistical significance. Although the results may suggest that MESNA is a controversial agent in preventing hemorrhagic cystitis caused by CY when hyperhydration protocol is used, further observation with a larger number of patients is required to establish a firm conclusion.

Topics: Adolescent; Child; Child, Preschool; Combined Modality Therapy; Cyclophosphamide; Cystitis; Female; Humans; Infant; Infusions, Intravenous; Leukemia; Male; Mesna; Stem Cell Transplantation

We studied the efficacy of mesna as a protectant for urotoxicity in pediatric patients receiving chemotherapy including oxazaphosphorines. Nineteen patients with malignant diseases (5 neuroblastoma, 3 acute lymphocytic leukemia, 4 acute non-lymphocytic leukemia, 2 non-Hodgkin lymphoma, 3 osteosarcoma and 2 rhabdomyosarcoma) were treated with a total of 106 courses of therapy between June of 1986 and May of 1989. Of these, no gross hematuria were seen. Microhematuria transiently occurred only in 2 courses (5%) of 1 patient (2%). These data indicated that mesna was highly effective for urotoxicity of oxazaphosphorines without any side effects, especially in pediatric patients.

Topics: Bone Neoplasms; Child; Cyclophosphamide; Cystitis; Female; Hematuria; Humans; Ifosfamide; Leukemia; Lymphoma, Non-Hodgkin; Male; Mercaptoethanol; Mesna; Neuroblastoma; Osteosarcoma; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Rhabdomyosarcoma

Topics: Bone Marrow Transplantation; Humans; Leukemia; Mercaptoethanol; Mesna; Premedication; Radiation-Protective Agents; Whole-Body Irradiation

Topics: Anemia, Aplastic; Bone Marrow Transplantation; Cyclophosphamide; Cystitis; Fluid Therapy; Furosemide; Hemorrhage; Humans; Leukemia; Mercaptoethanol; Mesna; Postoperative Complications

Topics: Adolescent; Adult; Bone Marrow Transplantation; Child; Cyclophosphamide; Female; Furosemide; Graft vs Host Reaction; HLA Antigens; Humans; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Male; Mesna

The effects of mesna (sodium 2-mercaptoethane-sulfonate) on the frequency of sister chromatid exchange (SCE) and chromosomal aberrations were studied in PHA-stimulated lymphocytes in vitro. Our data give no evidence for either an increase of SCE or chromosomal aberrations and, thus, do not suggest a mutagenic or cancerogenic potential of this drug, when used clinically for the reduction of urotoxicity caused by oxazaphosphorine derivatives in cancer therapy. The possibility of a radioprotective effect of mesna could not be supported by the results obtained in this test system. However, there remained a slight comutagenic effect of mesna, if used together with irradiation, which should be taken into account when this drug is administered in the preparation of patients for bone marrow transplantation.

Topics: Chromosome Aberrations; Crossing Over, Genetic; Drug Evaluation, Preclinical; Gamma Rays; Humans; In Vitro Techniques; Leukemia; Lymphocyte Activation; Lymphocytes; Mercaptoethanol; Mesna; Radiation-Protective Agents; Sister Chromatid Exchange

Topics: Bone Marrow Transplantation; Child; Child, Preschool; Cyclophosphamide; Cystitis; Female; Hemorrhage; Humans; Leukemia; Male; Mercaptoethanol; Mesna