It is very important the pwMS understand that if they have a vascular component to their disease, they need to speak with their prescribing doctors about the possible vascular side effects of their medications. Vascular conditions need to be discussed before beginning a chemotherapy treatment.
Also, if you have already been treated with a chemotherapy regimen for MS or cancer, you must inform your IR if your seek angioplasty to relieve CCSVI. These medications can have lifelong effects to your blood, blood vessels and cardiovascular system.
As most of us already know, chemotherapy and the new chemo infusion medications potentially expose you to opportunistic infections, such as PML. But they also can alter your heart function, blood and blood vessels.
When chemotherapy kills cells, the cells can release substances that cause an increase in blood clotting (coagulation). Specific types of chemotherapy drugs are more likely to cause a blood clot than others. Your doctor should explain to you if the drugs you are having increase your risk of getting a blood clot.
This is essential for those with a pre-existing vascular disorder, such as CCSVI. Other chemotherapies are potentially toxic to your cardiovascular system.
Cardiotoxicity is damage to the heart muscle, and a side effect of some chemotherapies. As a result of cardiotoxicity, your heart may not be able to pump blood through out your body as well. This may be due to chemotherapy drugs, or other medications you may be taking to control your disease. Cardiotoxicity,
if severe, may lead to cardiomyopathy.
Cardiomyopathy - Is often a result of treatments, such as chemotherapeutic medications, or may be caused by a group of diseases or disorders, that lead to damaged heart muscle. Injury to heart muscle may cause a disturbance in the heart's pumping action, and subsequent heart failure.
http://www.chemocare.com/managing/cardiotoxicity_and_cardiomyopathy.asp
Here are the most popular chemo-based multiple sclerosis treatments, and their warnings.
Campath (Alemtuzimab)
your blood:
This medication may cause very serious (rarely fatal) blood disorders (decreased bone marrow function leading to low number of blood cells such as red cells, white cells, and platelets). This effect can cause anemia, decrease your body's ability to fight an infection, or cause your body to bruise or bleed more easily.
Campath has received mixed reviews from the neurology community despite its efficacy, as it has been shown to cause idiopathic thrombocytopenic purpura (ITP), a blood disorder, in trials. The current label for Campath contains a label warning regarding the potential for developing serious blood complications with use.
Black Box warning-
Hematologic Toxicity
serious and rarely fatal pancytopenia/marrow hypoplasia, autoimmune idiopathic thrombocytopenia, and autoimmune hemolytic anemia observed; single doses >30 mg or cumulative doses >90 mg/wk incr. incidence of pancytopenia
How it affects the blood and coagulation---
There is a paucity of literature suggesting possible mechanisms for Campath causing renal failure or DIC (disseminated intravascular coagulation). Rankin et al.1 suggested that Campath could lead to an activation of the endothelium causing disturbances in coagulation and fibrinolysis, perhaps as a direct effect or by secondary cytokine release. Wada et al.2 found significantly elevated interleukin-6 and TNF levels in patients with DIC.
1. Rankin et al, Perturbation of coagulation and fibrinolysis during treatment with Campath-1H antibody. Br J Cancer, Suppl. 21,27, 1994.
2. Wada et al, Increased plasma level of interleukin-6 in disseminated intravascular coagulation. Blood Coagulation and Fibrinolysis. 1993 Aug; 4: 583-90. W.L. Osborne et al. 12
http://www.haematologica.org/cgi/reprint/90/1/ECR05.pdf
Rituxan (rituximab)
Black box warning-
your blood:
Rixuximab has a variety of hematologic side effects.[1] In clinical trials, series cytopenias were reported in 48 percent of patients treated with rituximab; these include: lymphopenia (40 %), neutropenia (6 %), leukopenia (4 %), anemia (3 percent ), and thrombocytopenia (2 %). The median duration of lymphopenia was 14 days (range 1-588 days) and of neutropenia was 13 days (range, 2 to 116 days). A single occurrence of transient aplastic anemia (pure red cell aplasia) and two occurrences of hemolytic anemia following rituximab therapy were reported.
your heart:
Fatal Infusion Reactions. Deaths within 24 hours of rituximab infusion have been reported. These fatal reactions followed an infusion reaction complex which included hypoxia, pulmonary infiltrates, acute respiratory distress syndrome, myocardial infarction, ventricular fibrillation or cardiogenic shock. Approximately 80 percent of fatal infusion reactions occurred in association with the first infusion.
http://www.medscape.com/viewarticle/523577_4
Novantrone-
Black box warning-
your heart:
Cardiotoxicity: Congestive heart failure (CHF), potentially fatal, may occur either during therapy with NOVANTRONE® or months to years after termination of therapy. Cardiotoxicity risk increases with cumulative NOVANTRONE dose and may occur whether or not cardiac risk factors are present. Presence or history of cardiovascular disease, radiotherapy to the mediastinal/pericardial area, previous therapy with other anthracyclines or anthracenediones, or use of other cardiotoxic drugs may increase this risk.
http://ms.about.com/od/treatments/a/What-Is-A-Black-Box-Warning-For-Ms-Drugs.htm
Cytoxan (Cyclophosphamide)
your heart:
Acute cardiac toxicity has been reported with doses as low as 2.4 g/m2 to as high as 26 g/m2, usually as a portion of an intensive antineoplastic multi-drug regimen or in conjunction with transplantation procedures. In a few instances with high doses of cyclophosphamide, severe, and sometimes fatal, congestive heart failure has occurred after the first cyclophosphamide dose. Histopathologic examination has primarily shown hemorrhagic myocarditis. Hemopericardium has occurred secondary to hemorrhagic myocarditis and myocardial necrosis. Pericarditis has been reported independent of any hemopericardium.
your blood:
Hemorrhagic cystitis may develop in patients treated with cyclophosphamide. Rarely, this condition can be severe and even fatal.
http://www.druglib.com/druginfo/cytoxan/warnings_precautions/
Please, discuss any treatments you have received with your neurologists and vascular specialists. It is all very important in going forward with research of angioplasty for CCSVI. There is much to be learned about venous scarring, clotting and restenosis. If chemotherapy is involved in altering the lining of the blood vessels, or changing the function of the heart, it must be disclosed to all treating doctors.
Joan