Letters to Editor
patient who had multiple myeloma. The patient improved well, once the offending drug was stopped. Following this, Oshima et al.[5] reported, after extensive search of Adverse Event Reporting System (AERS) of Food and Drug Administration (FDA) website, that 10 of 681 cases who were started on lenalidomide developed alveolar hemorrhage. Like in our patient, of the 10 cases, 7 had a fatal outcome. The main stay of treatment of alveolar hemorrhage is withdrawal of the offending drug, and ruling out other causes such as infections including pneumocystitis carinii pneumonia. Role of corticosteroids in the treatment of lenalidomide‑induced pulmonary toxicity is not clear. Drug‑induced pulmonary toxicity usually is a life threatening situation as it produces rapid clinical deterioration, just as we encountered in this patient.
Departments of Pulmonary Medicine, and 1Hematology, Christian Medical College, Vellore, Tamil Nadu, India E‑mail: [email protected]
REFERENCES 1. 2. 3. 4. 5. 6. 7.
In conclusion, clinicians should consider adverse drug reactions as one of the differentials in a patient who presents with new onset respiratory symptoms, hypoxia, and bilateral pulmonary infiltrate, in patient on antineoplastic agents.
Armoiry X, Aulagner G, Facon T. Lenalidomide in the treatment of multiple myeloma: A review. J Clin Pharm Ther 2008;33:219‑26. Sonpavde G, Hutson TE. Recent advances in the therapy of renal cancer. Expert Opin Biol Ther 2007;7:233‑42. Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al., editors. Harrison’s Principles of Internal Medicine. 18th ed. New York: McGraw Hill; 2012. Sakai M, Kubota T, Kuwayama Y, Ikezoe T, Yokoyama A. Diffuse alveolar hemorrhage associated with lenalidomide. Int J Hematol 2011;93:830‑1. Oshima Y, Tojo A. Pulmonary alveolar hemorrhage possibly associated with lenalidomide use. Int J Hematol 2011;94:296‑7. Vallet S, Palumbo A, Raje N, Boccadoro M, Anderson KC. Thalidomide and lenalidomide: Mechanism‑based potential drug combinations. Leuk Lymphoma 2008;49:1238‑45. List A, Kurtin S, Roe DJ, Buresh A, Mahadevan D, Fuchs D, et al. Efficacy of lenalidomide in myelodysplastic syndromes. N Engl J Med 2005;352:549‑57.
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Website: www.lungindia.com DOI:
S. Saheer, Balamugesh Thangakunam, Devasahayam Jesudas Christopher, Biju George1
10.4103/0970-2113.126004
DR‑70 immunoassay and malignant pleural effusion Sir,
Hainan Medical University, Haikou, Hainan, China. E‑mail: [email protected]
1
The topic of DR‑70 immunoassay and malignant pleural effusion (PE) is an interesting article in chest oncology.[1] In a study, Sengupta et al. reported that “DR‑70 assay has high sensitivity in detecting underlying lung cancer, but has no role in differentiating malignant PE from non‑malignant PE.”[1] There are many considerations on actual clinical use of DR‑70 immunoassay. First, the diagnostic property of this assay is only fair[1,2] and there are several cancers (such as lung, stomach, breast and rectum cancers) that can induce abnormal results.[2] In addition, the significant high level can be seen in the cases with advanced disease, which means no usefulness for early detection.[3] Finally, there is still no report confirming the cost‑effectiveness of this new test.
Beuy Joob, Viroj Wiwantikit1
REFERENCES 1. 2. 3.
Sengupta A, Saha K, Jash D, Banerjee SN, Biswas NM, Dey A. Role of DR‑70 immunoassay in suspected malignant pleural effusion. Lung India 2013;30:321‑6. Wu D, Zhou X, Yang G, Xie Y, Hu M, Wu Z, et al. Clinical performance of the AMDL DR‑70 immunoassay kit for cancer detection. J Immunoassay 1998;19:63‑72. Kerber A, Trojan J, Herrlinger K, Zgouras D, Caspary WF, Braden B. The new DR‑70 immunoassay detects cancer of the gastrointestinal tract: A validation study. Aliment Pharmacol Ther 2004;20:983‑7.
Access this article online Quick Response Code:
Website: www.lungindia.com DOI: 10.4103/0970-2113.126006
Sanitation 1, Medical Academic Center, Bangkok, Thailand,
Lung India • Vol 31 • Issue 1 • Jan - Mar 2014 91
Copyright of Lung India is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
patient who had multiple myeloma. The patient improved well, once the offending drug was stopped. Following this, Oshima et al.[5] reported, after extensive search of Adverse Event Reporting System (AERS) of Food and Drug Administration (FDA) website, that 10 of 681 cases who were started on lenalidomide developed alveolar hemorrhage. Like in our patient, of the 10 cases, 7 had a fatal outcome. The main stay of treatment of alveolar hemorrhage is withdrawal of the offending drug, and ruling out other causes such as infections including pneumocystitis carinii pneumonia. Role of corticosteroids in the treatment of lenalidomide‑induced pulmonary toxicity is not clear. Drug‑induced pulmonary toxicity usually is a life threatening situation as it produces rapid clinical deterioration, just as we encountered in this patient.
Departments of Pulmonary Medicine, and 1Hematology, Christian Medical College, Vellore, Tamil Nadu, India E‑mail: [email protected]
REFERENCES 1. 2. 3. 4. 5. 6. 7.
In conclusion, clinicians should consider adverse drug reactions as one of the differentials in a patient who presents with new onset respiratory symptoms, hypoxia, and bilateral pulmonary infiltrate, in patient on antineoplastic agents.
Armoiry X, Aulagner G, Facon T. Lenalidomide in the treatment of multiple myeloma: A review. J Clin Pharm Ther 2008;33:219‑26. Sonpavde G, Hutson TE. Recent advances in the therapy of renal cancer. Expert Opin Biol Ther 2007;7:233‑42. Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al., editors. Harrison’s Principles of Internal Medicine. 18th ed. New York: McGraw Hill; 2012. Sakai M, Kubota T, Kuwayama Y, Ikezoe T, Yokoyama A. Diffuse alveolar hemorrhage associated with lenalidomide. Int J Hematol 2011;93:830‑1. Oshima Y, Tojo A. Pulmonary alveolar hemorrhage possibly associated with lenalidomide use. Int J Hematol 2011;94:296‑7. Vallet S, Palumbo A, Raje N, Boccadoro M, Anderson KC. Thalidomide and lenalidomide: Mechanism‑based potential drug combinations. Leuk Lymphoma 2008;49:1238‑45. List A, Kurtin S, Roe DJ, Buresh A, Mahadevan D, Fuchs D, et al. Efficacy of lenalidomide in myelodysplastic syndromes. N Engl J Med 2005;352:549‑57.
Access this article online Quick Response Code:
Website: www.lungindia.com DOI:
S. Saheer, Balamugesh Thangakunam, Devasahayam Jesudas Christopher, Biju George1
10.4103/0970-2113.126004
DR‑70 immunoassay and malignant pleural effusion Sir,
Hainan Medical University, Haikou, Hainan, China. E‑mail: [email protected]
1
The topic of DR‑70 immunoassay and malignant pleural effusion (PE) is an interesting article in chest oncology.[1] In a study, Sengupta et al. reported that “DR‑70 assay has high sensitivity in detecting underlying lung cancer, but has no role in differentiating malignant PE from non‑malignant PE.”[1] There are many considerations on actual clinical use of DR‑70 immunoassay. First, the diagnostic property of this assay is only fair[1,2] and there are several cancers (such as lung, stomach, breast and rectum cancers) that can induce abnormal results.[2] In addition, the significant high level can be seen in the cases with advanced disease, which means no usefulness for early detection.[3] Finally, there is still no report confirming the cost‑effectiveness of this new test.
Beuy Joob, Viroj Wiwantikit1
REFERENCES 1. 2. 3.
Sengupta A, Saha K, Jash D, Banerjee SN, Biswas NM, Dey A. Role of DR‑70 immunoassay in suspected malignant pleural effusion. Lung India 2013;30:321‑6. Wu D, Zhou X, Yang G, Xie Y, Hu M, Wu Z, et al. Clinical performance of the AMDL DR‑70 immunoassay kit for cancer detection. J Immunoassay 1998;19:63‑72. Kerber A, Trojan J, Herrlinger K, Zgouras D, Caspary WF, Braden B. The new DR‑70 immunoassay detects cancer of the gastrointestinal tract: A validation study. Aliment Pharmacol Ther 2004;20:983‑7.
Access this article online Quick Response Code:
Website: www.lungindia.com DOI: 10.4103/0970-2113.126006
Sanitation 1, Medical Academic Center, Bangkok, Thailand,
Lung India • Vol 31 • Issue 1 • Jan - Mar 2014 91
Copyright of Lung India is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
