This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
The synthetic antineoplastic anthracenedione mitoxantrone (MiTX) is well established as second-line treatment for worsening relapsing-remitting (RR) and secondary chronic progressive (SP) multiple sclerosis (MS).1 MiTX has a dose-related cardiotoxic potential which limits the cumulative lifetime dose in MS to 140 mg/m2. Up to a cumulative dose of 100 mg/m2, MiTX treatment is considered relatively safe.1,2 The risk of MiTX-induced congestive heart failure increases with the cumulative dose, previous treatment with anthracyclines, preexisting cardiovascular disease, and age. The development of acute severe heart failure shortly after initiation of MiTX treatment in MS has not been reported so far. Recently, the individual susceptibility to MiTX-induced side effects has been linked to naturally occurring genetic variations in ATP binding cassette (ABC) drug transporters.3
Case presentation.
The diagnosis of RRMS was established in an otherwise healthy 26-year-old woman in 2003. In November 2005 and February 2006, she received 2 doses of MiTX (12 mg/m2 body surface area per infusion) due to high disease activity without any immediate periprocedural complications. Before application of the first and second dose, physical examination, echocardiography, and electrocardiogram were normal. Two months after the second pulse, the patient rapidly developed a severe acute biventricular cardiac failure with a left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) of 10%, severe pulmonary edema, aspiration pneumonia, and hepatic and renal failure. After stabilization by artificial ventilation, catecholamine substitution, and hemofiltration, cardiac function subsequently improved, with LVEF …
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Disputes & Debates: Rapid online correspondence
- SEVERE CARDIAC FAILURE IN A PATIENT WITH MS FOLLOWING LOW-DOSE MITOXANTRONE TREATMENT
- Reply from the author
NOTE: All authors' disclosures must be entered and current in our database before comments can be posted. Enter and update disclosures at http://submit.neurology.org. Exception: replies to comments concerning an article you originally authored do not require updated disclosures.
- Stay timely. Submit only on articles published within the last 8 weeks.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- 200 words maximum.
- 5 references maximum. Reference 1 must be the article on which you are commenting.
- 5 authors maximum. Exception: replies can include all original authors of the article.
- Submitted comments are subject to editing and editor review prior to posting.