ADMINISTRATION OF ETHYOL (AMIFOSTINE) TO A CHILD WITH MEDULLOBLASTOMATO AMELIORATE HEMATOLOGICAL TOXICITY OF HIGH-DOSE CARBOPLATIN

The first report on the administration of the chemoprotective agent Et hyol (amifostine) in conjunction with high dose carboplatin to a patie nt in the pediatric/adolescent age group is presented. A 17 year old t eenager with recurrent cerebellar medulloblastoma received a total of five courses dose carboplatin 2 x 600 mg/m(2) (1200 mg/m(2)) in each c ycle. A complete response has been observed following the third treatm ent cycle. However, cumulative grade IV hematological toxicity develop ed following each of the first four treatments. Therefore, the fifth t reatment was administered in conjunction with amifostine, at a dose of 2 x 740 mg/m(2). Time to complete hematological recovery (Hb >100 g/l , granulocytes >2.0 G/I, platelets >100 G/I) was 52, 58, 72, 78 and 50 days, respectively, following treatments nos 1, 2, 3, 4 and 5. The du ration of grade Ill-IV neutropenia (<1.0 G/I) was 3, 7, 8, 10 and 5 da ys, respectively. The duration of grade II-IV thrombocytopenia (platel ets <75 G/I) was 10, 25, 35, 40 and 32 days, respectively. Grade IV th rombocytopenia (platelets <25 G/I) lasted for 5, 10, 12, 18 and 3 days , respectively, after each consecutive treatment. The total number of platelet transfusions was 1, 2, 2, 3 and 1, with the transfusion of 6, 9, 11, 11 and 5 units of platelets. The administration of amifostine has not been accompanied by any serious side effect. A short decrease in body temperature and a transient drop of blood pressure have been o bserved. Although hematological toxicity of high dose carboplatin has not been eliminated by amifostine, we conclude that significant protec tion was achieved in this situation of progressive bone marrow exhaust ion.