Teniposide


Semisynthetic derivative of podophyllotoxin which interacts with type II topoisomerase to induce DNA cross-links and double-strand breaks.
 
Incidence
2 to 11%.
 
41% of children with acute lymphoblastic leukemia treated with intensive multiagent chemotherapy.
 
Risk factors
Children with neuroblastoma or brain tumors.
 
High doses (children): 1500 to 2000 mg/ m2.
 
Clinical manifestations
(often on the first dose)
 
General: hypotension, oliguria, intravascular hemolysis, sweating, palor, fever.
 
Respiratory: chest pain, wheezing.
 
Cutaneous: flushing, urticaria, angioedema.
 
Diagnostic methods
In vitro histamine release from basophil leukocytes: non-specific histamine release.
 
One case with IgG 1 antibody to teniposide.
 
Mechanisms
Cremophor EL is thought to be the culprit (see cremophor EL).
 
Management
Premedication with diphenydramine corticosteroids is useful.
 
Etoposide does not usually cross-react.

References

  1. Kellie S.J, Crist W.M, Pui C.H, Crone M.E, Fairclough D.L, Rodman J.H, Rivera G.K, "Hypersensitivity reactions to epipodophyllotoxins in children with acute lymphoblastic leukemia", Cancer. , 1991; 67 (4): 1070-5
  2. Siddall S.J, Martin J, Nunn A.J, "Anaphylactic reactions to teniposide", Lancet., 1989; 1 (8634): 394
  3. Nolte H, Carstensen H, Hertz H, "VM-26 (teniposide)-induced hypersensitivity and degranulation of basophils in children", Am. J. Pediatr. Hematol. Oncol., 1988; 10 (4): 308-12
  4. O’Dwyer P.J, King S.A, Fortner C.L, Leyland-Jones B, "Hypersensitivity reactions to teniposide (VM-26): an analysis", J. Clin. Oncol., 1986; 4 (8): 1262-9

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.