Plasmapheresis reverses all side-effects of a cisplatin overdose – a case report and treatment recommendation

We report on a 46-year old woman with non-small cell lung cancer who accidentally received 225 mg/m2 of cisplatin, which was threefold the dose as scheduled, within a 3-day period. Two days later, the patient presented with hearing loss, severe nausea and vomiting, acute renal failure as well as elevated liver enzymes. In addition, she developed a severe myelodepression. After plasmapheresis on two consecutive days and vigorous supportive treatment, the toxicity-related symptoms improved and the patient recovered without any sequelae.To date, no general accepted guidelines for the treatment of cisplatin overdoses are available. Along with the experience from other published cases, our report shows that plasmapheresis is capable of lowering cisplatin plasma and serum levels efficiently. Therefore, plasma exchange performed as soon as possible can ameliorate all side effects of a cisplatin overdose and be a potential tool for clinicians for treatment. However, additional intensive supportive treatment-modalities are necessary to control all occurring side effects.Cisplatin is a widely used antineoplastic agent which is effective against different types of tumours. In addition to its high antitumour activity, cisplatin is a drug with potential side effects including nephro-, neuro-, myelo- and ototoxicity, as well as liver damage and severe emesis. These toxicities are dose-dependent and dose- and therapy-limiting. The maximum tolerated single dose of cisplatin is considered to be 100 to 120 mg/m2 per cycle and should be administered with adequate pre- and posthydration [1,2]. However, accidental overdose of cisplatin may occur despite all precautions and to date, no general accepted guidelines for the treatment of such cases are available.We report on a 46-year-old female patient with histologically proven adenocarcinoma of the right lung. The patient underwent pneumonectomy and unilateral lymphadenectomy in December 2001. Because of histologically verified positive r