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Pixantrone is a first drug aza-anthracenedione approved as monotherapy of relapsed or refractory aggressive lymphomas. This drug has the unique chemical structure and mode of action properties distinguishing it from anthracyclines and anthracenediones. Pixantrone is one of the treatment option for heavily pretreated patients which to receive their living with doxorubicin and the further application from anthracyclines potentially can lead anthracycline-induced congestive heart failure.
The benefit of pixantrone treatment has not been established in patients when used as V line or greater chemotherapy in patients who are refractory to last therapy. In general, pixantrone seems to be safe and manageable. In various trials, there were no unexpected side effects reported and no trials were closed prematurely because of side effects. In an evaluation of 12 clinical trials with pixantrone, the most common side effect (all grades) was hematological toxicity, mainly neutropenia (50% of patients; grade third/fourth: 41%), leukopenia (25%), anemia (31%), and thrombocytopenia (21%). Hematological toxicity was the main reason for a delayed start of subsequent cycles or for omitting the day-15 dose of pixantrone. In the outpatient setting, it is worth considering the use of hematopoietic growth factors. Other side effects included asthenia (23%), pyrexia (23%), and nausea, most patients experienced reversible skin discoloration.
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