Management of Daunorubicin Extravasation with Dexrazoxane in a Child
Abstract
The extravasation of anthracyclines during chemotherapy can harm the surrounding soft tissue, necessitating prompt management. In this report, we discuss a four-yearold boy who was treated with daunorubicin (an anthracycline) for acute lymphoblastic leukemia (ALL), during which extravasation occurred, and we addressed this issue using dexrazoxane. A four-year-old boy undergoing chemotherapy for ALL received daunorubicin, which extravasated. This led to cutaneous inflammation, prompting the discontinuation of the drug. Dexrazoxane was administered for three days, along with dimethyl sulfoxide spray. Severe cutaneous irritation and burning sensations occurred immediately after the application of the spray and continued until the
site was washed. Subsequently, the patient developed a catheter-related infection, exhibiting severe dyspnea, hypotension, and pulmonary edema. He was admitted to the pediatric intensive care unit for appropriate treatment. Dexrazoxane is a valuable option for managing anthracycline extravasation; however, our case revealed a severe reaction to the initial dose of dimethyl sulfoxide spray, suggesting that dexrazoxane
may be the safer choice for handling such extravasation cases.
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[9] Al-Aamri HM, Ku H, Irving HR, Tucci J, Meehan-Andrews T, Bradley C. Time dependent response of daunorubicin on
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[10] Boschi R, Rostagno E. Extravasation of antineoplastic agents: prevention and treatments. Pediatr Rep. 2012;4(3):e28.
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[15] Conde-Estévez D, Mateu-de Antonio J. Treatment of anthracycline extravasations using dexrazoxane. Clin Transl
Oncol. 2014;16(1):11-7. https://doi.org/10.1007/s12094-013-1100-7
[16] Madsen BK, Hilscher M, Zetner D, Rosenberg J. Adverse reactions of dimethyl sulfoxide in humans: a systematic
review. F1000Res. 2019;7:1746. https://doi.org/10.12688/f1000research.16642.2
[17] Liu D, Liu J, Xiao R, Deng A, Liu W. Safety evaluation of the combination with dexrazoxane and anthracyclines: a
disproportionality analysis based on the Food and Drug Administration Adverse Event Reporting System database.
Pharmaceuticals (Basel). 2024;17(12):1739. https://doi.org/10.3390/ph17121739
[18] Seif AE, Walker DM, Li Y, Huang YSV, Kavcic M, Torp K, et al. Dexrazoxane exposure and risk of secondary acute myeloid leukemia in pediatric oncology patients. Pediatr Blood Cancer. 2015;62(4):704-9. https://doi.org/10.1002/pbc.25043
[19]Cracknell AN, Dalby M, Chambers P, Robertson DL, Chan T, Kantilal K. Systematic review on the efficacy of
dexrazoxane in managing extravasation of anthracyclines. BMJ Connect Oncol. 2026;3(1). https://doi.org/10.1136/
bmjconc-2025-000075
[20] Romero ÁC, Ureña MTD, García AS, Fernández MTM, Porriño-Bustamante ML, Barrera JC. Extravasation accidents
with liposomal/liposomal pegylated anthracyclines treated with dexrazoxane: an overview and outcomes. Anticancer
Drugs. 2018;29(9):821-6. https://doi.org/10.1097/CAD.0000000000000672
[21] Bavare AC, Foster CE, Wollam AL, Campbell JR. Central lineassociated bloodstream infections in pediatrics: a review.
Pediatr Rev. 2025;46(9):510-9. https://doi.org/10.1542/pir.2024-006506
[2] Suttorp M, Millot F, Sembill S, Deutsch H, Metzler M. Definition, epidemiology, pathophysiology, and essential
criteria for diagnosis of pediatric chronic myeloid leukemia. Cancers (Basel). 2021;13(4):798. https://doi.org/10.3390/
cancers13040798
[3] Wei H, Wang Y, Gale RP, Lin D, Zhou C, Liu B, et al. Randomized trial of intermediate-dose cytarabine in induction and consolidation therapy in adults with acute myeloid leukemia. Clin Cancer Res. 2020;26(13):3154-61. https://doi.org/10.1158/1078-0432. CCR-19-3433
[4] Pophali P, Litzow M. What is the best daunorubicin dose and schedule for acute myeloid leukemia induction? Curr Treat Options Oncol. 2017;18(1):3. https://doi.org/10.1007/s11864-017-0446-4
[5] Perl AE. The role of targeted therapy in the management of patients with AML. Blood Adv. 2017;1(24):2281-94. https://doi.org/10.1182/bloodadvances.2017009829
[6] Saleem T, Kasi A. Daunorubicin. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020.
[7] Langer SW. Dexrazoxane for the treatment of chemotherapyrelated side effects. Cancer Manag Res. 2014;6:357-63. https://doi.org/10.2147/CMAR.S47238
[8] Duminuco A, Novello G, Mauro E, Scalisi E, Del Fabro V, Sambataro D, et al. Chemotherapy extravasation: diagnosis,
prevention and management. J Chemother. 2025;37(1):1-13.
[9] Al-Aamri HM, Ku H, Irving HR, Tucci J, Meehan-Andrews T, Bradley C. Time dependent response of daunorubicin on
cytotoxicity, cell cycle and DNA repair in acute lymphoblastic leukaemia. BMC Cancer. 2019;19(1):179. https://doi.
org/10.1186/s12885-019-5377-y
[10] Boschi R, Rostagno E. Extravasation of antineoplastic agents: prevention and treatments. Pediatr Rep. 2012;4(3):e28.
https://doi.org/10.4081/pr.2012.e28
[11] Wengström Y, Geerling J, Rustøen T. European Oncology Nursing Society breakthrough cancer pain guidelines. Eur J Oncol Nurs. 2014;18(2):127-31. https://doi.org/10.1016/j. ejon.2013.11.009
[12] Le A, Patel S. Extravasation of noncytotoxic drugs: a review of the literature. Ann Pharmacother. 2014;48(7):870-86. https://doi.org/10.1177/1060028014527820
[13] Fidalgo JP, Fabregat LG, Cervantes A, Margulies A, Vidall C, Roila F, et al. Management of chemotherapy extravasation: ESMOEONS clinical practice guidelines. Ann Oncol. 2012;23(Suppl 7):vii167-73. https://doi.org/10.1093/annonc/mds294
[14] Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs. 2017;21(4):438-45.
[15] Conde-Estévez D, Mateu-de Antonio J. Treatment of anthracycline extravasations using dexrazoxane. Clin Transl
Oncol. 2014;16(1):11-7. https://doi.org/10.1007/s12094-013-1100-7
[16] Madsen BK, Hilscher M, Zetner D, Rosenberg J. Adverse reactions of dimethyl sulfoxide in humans: a systematic
review. F1000Res. 2019;7:1746. https://doi.org/10.12688/f1000research.16642.2
[17] Liu D, Liu J, Xiao R, Deng A, Liu W. Safety evaluation of the combination with dexrazoxane and anthracyclines: a
disproportionality analysis based on the Food and Drug Administration Adverse Event Reporting System database.
Pharmaceuticals (Basel). 2024;17(12):1739. https://doi.org/10.3390/ph17121739
[18] Seif AE, Walker DM, Li Y, Huang YSV, Kavcic M, Torp K, et al. Dexrazoxane exposure and risk of secondary acute myeloid leukemia in pediatric oncology patients. Pediatr Blood Cancer. 2015;62(4):704-9. https://doi.org/10.1002/pbc.25043
[19]Cracknell AN, Dalby M, Chambers P, Robertson DL, Chan T, Kantilal K. Systematic review on the efficacy of
dexrazoxane in managing extravasation of anthracyclines. BMJ Connect Oncol. 2026;3(1). https://doi.org/10.1136/
bmjconc-2025-000075
[20] Romero ÁC, Ureña MTD, García AS, Fernández MTM, Porriño-Bustamante ML, Barrera JC. Extravasation accidents
with liposomal/liposomal pegylated anthracyclines treated with dexrazoxane: an overview and outcomes. Anticancer
Drugs. 2018;29(9):821-6. https://doi.org/10.1097/CAD.0000000000000672
[21] Bavare AC, Foster CE, Wollam AL, Campbell JR. Central lineassociated bloodstream infections in pediatrics: a review.
Pediatr Rev. 2025;46(9):510-9. https://doi.org/10.1542/pir.2024-006506
| Files | ||
| Issue | Vol 11 No 1 (2026): January-February | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v11i1.22173 | |
| Keywords | ||
| Daunorubicin Dexrazoxane Dimethyl sulfoxide Extravasation of diagnostic and therapeutic materials | ||
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How to Cite
1.
Ardakani Moghadam M, Noory M, Kaji Yazdi M. Management of Daunorubicin Extravasation with Dexrazoxane in a Child. CRCP. 2026;11(1):27-30.
