MULTIORGAN FAILURE ASSOCIATED WITH LOMUSTINE OVERDOSE

OBJECTIVE: To report a lomustine overdose in a patient with anaplastic astrocytoma. CASE SUMMARY: A 28-year-old woman with anaplastic astroc ytoma was treated with partial resection and radiation therapy followe d by a lomustine-containing regimen. The patient rook lomustine 1400 m g po over a week, her regular dose being 200 mg on day 1 of the regime n. Pancytopenia developed within a week after the last dose of lomusti ne and the patient was admitted to the bone marrow transplant unit for supportive care. About 3 weeks later, the patient gradually developed a multiorgan dysfunction, including liver, brain, and lungs without e vidence of infection or tumor progression, and died on day 45 of hospi talization. DISCUSSION: This is the third reported case of lomustine o verdose that resulted from supplying the patient with more tablets tha n needed for 1 dose. Although late hematopoietic recovery may be possi ble after such a high dose of lomustine, other organ toxicities might be detrimental. CONCLUSIONS: Physicians and pharmacists should avoid s upplying more tablets than needed for 1 lomustine dose. High doses of lomustine may cause irreversible multiorgan toxicities.