Case Reports
Tuesday, October 15, 2024
08:30 AM–10:00 AM
Abstract
Introduction: Liposomal cytarabine and daunorubicin (CPX-351) can be used for treatment of relapsed AML. Once reconstituted it contains 5 mg/mL copper gluconate and has a warning for copper overload in the prescribing information.
Case: A 9-year-old male was transferred to St. Jude Children’s Research Hospital to pursue chemotherapy for relapsed AML presenting with abdominal distension, ascites, and abdominal mass concerning for chloroma. On arrival, he was receiving total parenteral nutrition (TPN) containing trace elements. Routine TPN labs obtained the following morning resulted a copper level of 153.5 ug/dL (reference range: 75-153 ug/dL). He started CPX-351 a week later 59 mg/m2 given on day 1, dose reduced to 30 mg/m2 on days 3 and 5 with concern for rising total bilirubin. Trace elements were removed from TPN two days after the first CPX-351 dose secondary to rising bilirubin. Copper level collected three days after his first dose was elevated at 344.2 ug/dL. Copper level was repeated 7 and 16 days after he completed CPX-351 and remained elevated at 181 ug/dL and 176.3 ug/dL. Total copper gluconate dose from CPX-351 course was 360 mg (270 mg/m2). This patient did not exhibit signs of copper toxicity and did not receive chelation therapy. No other causes for acute rise in copper level were identified. He clinically improved and was discharged on TPN 9 days after his last CPX-351 dose.
Discussion: This is the first pediatric report that trends copper levels following CPX-351. Two prospective adult studies, median age >60 years, reported a rise in copper levels 5-7 times baseline and decreased to baseline 6.5 and 10.4 days after the day 5 dose.
Conclusion: Patients requiring TPN following administration of CPX-351 may not require copper supplementation with trace elements and should have copper levels monitored as well as evaluation for signs of copper toxicity.
Presenting Author
Hope Swanson PharmDSt. Jude Children's Research Hospital
Authors
Patricia Barker PharmD
St. Jude Children's Research Hospital
Raul Ribeiro MD
St. Jude Children's Research Hospital
Stephanie Shive MSN
St. Jude Children's Research Hospital