Cancer therapy complications and supportive care: Case

This boy presents three overlapping toxicities of the high emetogenic induction regimen that the supportive care is built to manage. The breakthrough vomiting despite the ondansetron alone signals the antiemetic combination that is underpowered for the risk, because the cyclophosphamide above one gram per square metre is a high emetogenic agent. The extensive oral ulceration that stops the eating and the drinking is the severe mucositis of the WHO grade 3 or 4. The single temperature of 38.7 degrees with the absolute neutrophil count of 120 is the febrile neutropenia that needs the antibiotic within the hour. The heart rate of 140 and the daunorubicin exposure frame the cardiac risk that the dexrazoxane protects across the treatment. ^[1][9]

Interpretation of the three problems

The three problems are the breakthrough chemotherapy-induced nausea and vomiting, the severe oral mucositis, and the febrile neutropenia, and each has a specific interpretation. The cyclophosphamide above one gram per square metre is a high emetogenic agent, and the vomiting despite the ondansetron alone is the predictable consequence of the underpowered prophylaxis, because the high risk demands the three-drug combination. The extensive ulceration of the tongue and the buccal mucosa with the bleeding and the refusal of all food and fluid meets the WHO grade 3, the ulcers with the liquid diet only, and the grade 4 if the oral intake is impossible. ^[1][4]

The single temperature of 38.7 degrees with the absolute neutrophil count of 120 is the febrile neutropenia, because the threshold is the single oral temperature at or above 38.3 degrees with the count under 500. The heart rate of 140 with the capillary refill of two seconds and the normal blood pressure places the boy in the compensated rather than the decompensated state, but the neutropenic sepsis can deteriorate rapidly, and the well appearance is deceptive. The daunorubicin in the regimen frames the anthracycline exposure that the dexrazoxane must protect across the induction and the maintenance, and the cumulative dose is tracked from the start. ^[9]