Table 3. Toxicity of valproic acid (VPA)a.
NCI – CTC grade
|
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---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | ||||
VPA dose (mg kg−1 day−1) | No. of patients | Median duration (weeks) | Toxicity | (No. of patients) | (No. of patients) | (No. of patients) | (No. of patients) |
VPA alone | |||||||
10–30b | 17 | 6 | Leukocytosis | 2 | |||
Thrombocytosis | 1 | ||||||
Anemia | 2 | 2 | |||||
Nausea/vomiting | 2 | ||||||
Abdominal pain | 1 | 1 | |||||
Asthenia | 3 | ||||||
Erithema | 1 | ||||||
Hepatic (ALP, LDH) | 1 | ||||||
Amylase | 3 | 1 | |||||
Dyspnea (pleural eff.) | 1 | ||||||
Depr. consciousness | 1 | ||||||
60–90c | 11 | 6 | Thrombocytopenia | 1 | |||
Anemia | 1 | 1 | 1 | 1d | |||
Asthenia | 1 | ||||||
Constipation | 1d | ||||||
Sciatic pain | 1 | ||||||
Infection | 2d | ||||||
Creatinine | 1 | ||||||
Hematuria | 1d | ||||||
Hypoacusis | 1d | ||||||
Dyspnoea | 1 | ||||||
Ataxia | 1 | ||||||
Depr. consciousness | 1d | 1 | |||||
VPA in combination with chemoimmunotherapy | |||||||
30 | 3 | 3 | Anemia | 1 | |||
Asthenia | 2 | ||||||
Hepatic (AST) | 1 | ||||||
Tremors | 1 | ||||||
60 | 12 | 14 | Leukopenia | 2 | 4 | ||
Neutropenia | 2 | 3 | |||||
Thrombocytopenia | 3 | 1 | 4 | ||||
Anemia | 2 | 3 | 1 | 1 | |||
Nausea/vomiting | 6 | ||||||
Diarrhea | 3 | 1 | |||||
Asthenia | 2 | ||||||
Ammonia | 2 | ||||||
Hepatic (any) | 3 | ||||||
Gastric pain | 2 | ||||||
Fever | 1 | 1 | |||||
Hypocalcemia | 1 | ||||||
Depr. consciousness | 3 | 3 | 1 | 1 | |||
Other neurologicale | 2 | 6 | 2 | 1 | |||
Cerebral hemorrhage | 1 | ||||||
Urinary incontinence | 1 | 1 | |||||
90 | 3 | 3 | Leukopenia | 1 | |||
Thrombocytopenia | 1 | 1 | |||||
Anemia | 1 | ||||||
Hepatic (AST) | 1 | ||||||
Amylase | 1 | ||||||
Headache | 1 |
On 28 assessable patients. Each patient is reported in each section of the table (VPA alone, and VPA in combination with chemoimmunotherapy) within the row corresponding to the highest dose level he received during the pertinent period of therapy. Some patients had dose reductions of VPA already during the induction phase, and others had dose escalation during the combination phase. All patients except one had some kind of toxicity.
Three patients at 10 mg kg−1 day−1, 14 patients at 30 mg kg−1 day−1.
10 patients at 60 mg kg−1 day−1, one patient at 90 mg kg−1 day−1.
90 mg kg−1 day−1, with bladder progression of disease.
Vertigo, hallucinations, headache, speech impairment, mood alteration, memory loss, paraesthesia, seizures, tremors, confusion.