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PubMed1995

An unwanted side effect of hydroxyurea in a patient with idiopathic myelofibrosis.

A patient with idiopathic myelofibrosis is reported who developed a drug fever after treatment with hydroxyurea, a generally effective and well-tolerated drug in chronic myeloproliferative syndromes. Typically, this form of fever develops after a few weeks of exposure to the drug and disappears with discontinuation of the drug. Possible interactions with prostaglandin or leukotriene metabolism may play a role.

Aged↗

PubMed1980

Effects of hydroxyurea on postnatal growth and behaviour of rats.

Hydroxyurea was administered intraperitoneally to pregnant albino rats in a single dose of 2000 mg/kg on day 14 of gestation. Both the perinatal and postnatal mortality rates of the progeny were increased and their weight gain reduced. Exploratory locomotion of 32-day-old rats, calculated by means of an 'activity index', was significantly reduced. The treatment had no effect on the brain weight. The fertility of the progeny was not impaired.

Animals↗

PubMed1994

Drug-specific rearrangements of chromosome 12 in hydroxyurea-resistant mouse SEWA cells: support for chromosomal breakage model of gene amplification.

In order to investigate whether specific, nonrandom chromosome rearrangements were involved in the induction of hydroxyurea (HU) resistance in mouse SEWA cells, we undertook detailed cytogenetic analyses of three independently selected lines during the long-term treatment with HU. We found that cells with trisomy 12 had selective advantage during early steps of HU treatment. Subsequently, numerous rearrangements of chromosome 12 took place in each of the HU-resistant cell lines. More specifically, the proximal end of chromosome 12 (band A3) was frequently involved in breaks and fusions generating multicentric marker chromosomes. In situ hybridization showed that the functional Rrm2 gene was located in this particular region of chromosome 12. Furthermore, amplification and rearrangements of the structural gene Rrm2 were detected both at the chromosomal and at the molecular level. As discussed, the results of the cytogenetic analyses support the chromosomal breakage model of gene amplification.

Animals↗

PubMed1977

Compared effects of N-hydroxyurethan, urethan and hydroxyurea on DNA synthesis. In vivo and in vitro studies.

The effect of N-hydroxyurethan (HUR) on DNA synthesis has been tested both in vivo on various tissues and in vitro on concanavalin A (ConA)-stimulated rat thymocytes and compared with the action of urethan and hydroxyurea. HUR suppresses scheduled DNA synthesis, except that of non-stimulated spleen cells in vitro. The inhibition is efficient and rapid and takes place immediately if the drug is administered at the peak of the S-phase. UR inhibits DNA synthesis in vitro only at much higher doses and with different time course. It is effective or slightly effective if it is administered at the peak of the S-phase. A conversion of urethan into HUR the latter depressing DNA synthesis could partly explain the differences observed. No toxicity was found after treatment with drugs at the concentration employed. Finally, the relationships between drug doses and cell responses have been particularly observed in vivo.

Animals↗

PubMed1984

Comparison of single time point and linear regression estimates of cell production in rat intestinal crypts after perturbation by hydroxyurea.

The present investigation compared the values obtained for the intestinal crypt cell production rate per hour ( CCPR ) at several sites in the intestine of rats using two variations in the application of metaphase arrest technique. The CCPR was determined both from the slope of a metaphase accumulation line obtained by linear regression analysis of measurements at several time points and by the single time point accumulation method. The comparison was performed for both the steady state in untreated controls and under perturbed conditions at 6, 12 and 24 h following intraperitoneal administration of 1000 mg/kg bodyweight of hydroxyurea to rats. In the steady state, the metaphase accumulation values were linear up to 3 h after vincristine sulfate in the proximal intestine (stomach to proximal ileum) and linear for up to 3 1/2 h in the distal ileum and the colon. Consequently the 3 h time point was selected for evaluation of CCPR values using the single time point method. The two methods gave equivalent results in the steady state, although in situations where there was good linearity of metaphase accumulation, the values obtained by the regression method were usually more precise. In the perturbed intestine poorer linearity of metaphase accumulation was observed and the duration of linearity was reduced sometimes to 2-2 1/2 h. Overall, under these circumstances, estimation of average CCPR was more precise by the single time point accumulation method. More importantly, significant differences were sometimes evident between the results of these two methods when applied to the same data.

Animals↗

PubMed1990

Implications and problems in analysing cytotoxic activity of hydroxyurea in combination with a potential inhibitor of ribonucleotide reductase.

The cytotoxicity of hydroxyurea in combination with 2.2'-bipyridyl-6-carbothioamide (a potential inhibitor of ribonucleotide reductase) on P388 murine leukemia is reported. Synergistic activity was studied using various interpretations of the isobologram method and the combination index method. We evaluated the pros and cons of these methods and their overall usefulness. In our opinion, to obtain all possible information from a compound association, it is important to choose a formally correct method that (a) can quantitatively evaluate synergism or antagonism, (b) may offer the possibility of averaging final results, (c) needs a minimal amount of experimental data, and (d) is rapid. Moreover, we emphasize both the utility of testing at least three molar ratios of compound association and the importance of carefully choosing the fractional inhibition used in calculating the combination effect. Such evaluation of drug combinations gives information essential to the preparation of new anticancer drug regimens and to the early assessment of biochemical interactions.

2,2'-Dipyridyl↗

PubMed1982

Effects of hydroxyurea on DNA synthesis in hairless mouse epidermis.

The effect of 5 mg hydroxyurea (HU) i.p. on epidermal DNA synthesis in female hairless mice was assessed by measuring labelling indices and specific activity after 3HTdR injection, flow cytometry (FCM) and cell sorting of prelabelled basal cells. HU causes an almost immediate block in DNA synthesis lasting until 2-2.5 h. During this time the fraction of cells in S remains stationary, 1.20 of normal. From 2.5 to 12.5 h DNA synthesis is resumed, but in cells recruited from G1 or G0. The HU-blocked cells do not move out of S until after 12.5 h. Hence, from 2.5 to 12.5 h, the fraction of cells in S increases to 2.5 of normal, which means that entry into S is open, but exit is blocked. From 12.5 h flux through S is high. The blocked cells are now released and the fraction of cells in S falls to 0.7 of normal at 24.5 h. At 36.5 h a probable new wave of DNA synthesis is indicated. The results also show that 3HTdR is available for at least 20 min after i.p. injection. The consequences of these results for the interpretation of the effect of HU pretreatment on methylnitrosourea skin carcinogenesis are discussed.

Animals↗

PubMed2002

Leukemogenic risk of hydroxyurea therapy as a single agent in polycythemia vera and essential thrombocythemia: N- and K-ras mutations and microsatellite instability in chromosomes 5 and 7 in 69 patients.

Polycythemia vera (PV) and essential thrombocythemia (ET) are chronic myeloproliferative diseases that carry intrinsically the potential for leukemic transformation. The aims of this study were (1) to detect involvement of N- and K-ras mutations in codons 12 and 13 in the pathogenesis of the chronic and blastic phases of PV and ET, (2) to study the occurrence of microsatellite instability (MSI) in chromosomes 5 and 7 during the chronic phase and blastic transformation of the disease, and (3) to examine the incidence of leukemia in patients treated with hydroxyurea (HU). Samples of PV and ET patients were analyzed with a polymerase chain reaction. No N- or K-ras mutations were detected. A positive score for MSI in chromosome 7 was found in 1 patient with PV during leukemic transformation. Three of 69 patients developed acute myelogenous leukemia, 2 with PV and 1 with ET. As of this report, the overall incidence of leukemic transformation is 5.7% (2/35 patients) in PV and 3.3% (1/30 patients) in ET patients treated with HU. These results indicate that (1) MSI is a genetic marker that can be detected, even in a small group of patients, at the blastic phase of the disease and (2) no increased leukemogenicity was noted in this group of patients treated with HU.

Adolescent↗

PubMed2006

Leg ulcers in elderly on hydroxyurea: a single center experience in Ph- myeloproliferative disorders and review of literature.

Hydroxyurea (HU) is effective in controlling thrombocytosis while reducing the risk of thrombosis in essential thrombocythemia (ET), polycythemia vera (PV) and myelofibrosis (MF). However, HU may carry more or less severe side-effects. Rare cases of patients with painful leg ulcers have been published. We report our experience on such a side-effect in a large cohort of patients with ET and PV treated with HU and review the literature on the topic. Five (4%) out of our 124 patients (69 ET, 51 PV, 4 MF; 49 males, 75 females; mean age at diagnosis 59.1+/-11.8 years) treated with HU developed painful leg ulcers. Sixty-one other patients affected with Phmyeloproliferative disorders (Ph- MPD) developing HU-related painful leg ulcers are described in the English literature. All our five patients were women and developed leg ulcers over the age of 75. Sixty-five percent of all described cases are women; 59% were over 65 years of age and 45% over 70. Most cases received over 1 gr HU per day for at least 1 year. The pathogenesis of HU-induced skin ulcers remains elusive. Treatment is difficult and requires prompt cessation of HU therapy.

Age Factors↗

PubMed2003

[Hydroxyurea-induced pneumonitis].

BACKGROUND: Hydroxyurea (HU) is a good-controllable and well-tolerated cytostatic drug. CASE REPORT: Two patients with a myeloproliferative disease, who suffered from fever, lung symptoms and reticulonodular infiltrates on both sides after 4 and 10 weeks of HU medication, are introduced. One patient additionally presented with multiple, 1-cm diameter, pustulous (central abscess-like), elevated, livid skin lesions on his forearms and shins. After discontinuance of the HU administration, symptoms vanished within 1-2 days, but could be reinduced by HU reexposition within hours. CONCLUSION: Nine cases with a pneumonitis (alveolitis or interstitial lung disease) have been described so far. In all cases, including ours, HU medication was usually administered over a 3- to 12-week period, mostly for 4 weeks (five of eleven cases). All patients showed a uniform illness with fever (11/11), chills (6/11), reticular or nodular infiltrates on both sides (11/11), small pleural effusions (5/11), and lung symptoms (11/11) such as dyspnea (10/11) or cough (5/11). Due to the acute or subacute onset, all cases were first misinterpreted as bacterial pneumonia.

Antineoplastic Agents↗

PubMed2003

High-dose hydroxyurea in the treatment of poor-risk myeloid leukemias.

The aim of the study was to evaluate the antileukemic effectiveness and toxicity of high-dose hydroxyurea (HHY) and to assess its acute toxicity. Between August 1997 and October 1998, 12 consecutive adult patients (>18 years) with high-risk acute myeloid leukemia (AML) (four patients in first early relapse, seven patients with secondary AML, and one patient with de novo AML concomitant to a lymphoproliferative disorder) were enrolled to receive a single course of HY (100 mg/kg per day) until bone marrow aplasia or for a maximum of 30 days. Of the 12 patients, 5 (41.6%) achieved complete remission (CR), 1 achieved partial remission (PR), 4 were resistant to treatment, and 2 died during induction from infection. No patient with relapsed AML achieved CR, while it was achieved by five of eight patients with secondary AML at diagnosis; five of six MDR1+ patients achieved CR. As concerns follow-up of the CR patients, one did not receive any further treatment and died in CR from pulmonary aspergillosis, and one with a concomitant chronic lymphocytic leukemia (CLL) received two courses of FLAG (fludarabine, cytarabine, granulocyte colony-stimulating factor) regimen with disappearance of the clonal Ig rearrangement, but relapsed after 11 months and died from pneumonia. The remaining three patients were consolidated with two courses of high-dose cytosine arabinoside (AraC), followed by peripheral blood stem cell transplantation (PBSCT) in one patient. One of them relapsed after 3 months, while the other two are still in continuous complete remission (CCR) after 16 and 28 months, respectively. This study has demonstrated the safety and efficacy of HHY in inducing CR in AML patients with unfavorable prognosis. Despite the small number of patients, these encouraging results warrant further studies.

Adult↗

PubMed2004

Hydroxyurea in the treatment of major beta-thalassemia and importance of genetic screening.

Efforts have been undertaken to find an alternative approach to packed red cell transfusion (PRCT) in major beta-thalassemia. Augmentation of fetal hemoglobin (HbF) by hydroxyurea (HU) has been reported to be less effective in this condition as compared to sickle cell anemia due to molecular heterogeneity of the former disease. HU efficacy and its relation to Xmn1 polymorphism and IVSII-1 mutation was evaluated in major beta-thalassemics. Forty-five patients, M/F ratio 0.8, aged 6-33 years, received oral HU, 20 mg/kg per day, 4 days per week and daily1 mg folic acid. Thirty-six patients were PRCT dependent (group A) and nine independent (group B). The aim was to stabilize or increase pre-PRCT Hb over 10.0+/-0.5 g/dl and to reduce the need or cease the PRCT in group A and to increase Hb level and curb the ineffective erythropoesis, e.g., splenomegaly, facial bone deformity, in group B. HU was administered for at least 6 months (mean: 9 months) and discontinued in case of response failure. Screening for Xmn1 polymorphism and IVSII-1 mutation was carried out in most patients. In group A, 25 patients have become PRCT independent for a period of 2.5-7.3 years (mean: 4 years). The mean Hb, pre-HU 10.0 and post-HU 10.7 g/dl (range: 8.8-13.7 g/dl), mean serum ferritin pre- and post-HU was1877 and 525 ng/ml. The PRCT requirement was reduced in one patient, and ten patients did not respond. In group B HU has been given over 3.3 years (range: 2.8-4.8 years), Hb increased from 9.3 to 10.4/dl, and there was no tangible progression of ineffective erythropoesis. Responders in both groups expressed more comfort with this regimen. Xmn1 and IVSII-1 (homo- and/or heterozygosis) are relevant markers in most responding patients. Molecular determination of genetic markers in early childhood will help to identify candidates for pharmacological HbF switching by HU.

Adolescent↗

PubMed2005

Hydroxyurea in thalassemia intermedia--a promising therapy.

Pharmacological agents such as hydroxyurea (HU) have been known to cause induction of fetal hemoglobin and possibly may alleviate the symptoms in thalassemia intermedia patients. Thirty-seven patients with beta-thalassemia intermedia were enrolled to assess response to HU therapy. Major response was defined as transfusion independence or hemoglobin rise of more than 20 g/l and minor response as rise in hemoglobin of 10-20 g/l or reduction in transfusion frequency by 50%. The median age was 10 years (range: 4-50 years) and median follow-up was 12 months (range: 4-36 months). Twenty-six patients (70.2%) showed response to HU therapy. Seventeen patients (45.9%) were major responders, and nine patients (24.3%) showed minor response. There was no correlation of response with beta-thalassemia mutation or XmnI polymorphism; however, the presence of alpha(3.7) deletion was associated with major response in three patients. Mean fetal hemoglobin (HbF) levels rose on HU therapy. Older age, low baseline F cell percent, and low baseline HbF levels (below 10%) were predictors of poor response. Response was evident within 1 month of starting HU therapy in the majority of responders. Thus, a short trial of HU therapy can predict durable response.

Administration, Oral↗

PubMed1995

Population pharmacokinetics of hydroxyurea in cancer patients.

The pharmacokinetics of hydroxyurea (HU) were investigated in cancer patients after intravenous infusion or oral administration. On the basis of the minimal value of the objective function (MVOF) and prior knowledge of the disposition of HU in animals and man, the data were best described by a one-compartment pharmacokinetic model with parallel Michaelis-Menten metabolism and first-order renal excretion. The computer program NONMEM (nonlinear mixed effects model) was used to perform the nonlinear regression and provide estimates of the population parameters. For the combined intravenous and oral data set, these parameters were estimated to be: maximal elimination rate (Vmax), 0.097 mmol h-1 l-1; Michaelis constant for HU elimination (KM), 0.323 mmol/l; renal clearance (ClR), 90.8 ml/min; volume of distribution (Vd), 0.186 x (body weight) + 25.4 l; absorption rate constant (Ka), 2.92 h-1; and availability to the systemic circulation (F), 0.792. The principal findings of the investigation are that HU undergoes nonlinear elimination in cancer patients and that HU is reasonably well absorbed following oral administration.

Administration, Oral↗

PubMed1996

Interferon augments the cytotoxicity of hydroxyurea without enhancing its activity against the M2 subunit of ribonucleotide reductase: effects in wild-type and resistant human colon cancer cells.

The effects of prolonged exposure to the ribonucleotide reductase (RR) inhibitor, hydroxyurea (HU), were assessed in the presence or absence of recombinant interferon alfa-2a (IFN) in wild-type human colon cancer cells (HT-29) and variants expressing low-level resistance to HU (R200). IFN at nontoxic concentrations decreased the IC50 of HU from 368 microM to 215 microM (P < 0.01) in wild-type cells, but not in the resistant variants. Potential cellular targets for the HU/IFN interaction were examined. In wild-type, but not resistant cells, treatment with HU at clinically achievable concentrations (1000 microM) resulted in rapid early inhibition of RR activity between 4 and 24 h after treatment with a maximal decrease of 65% at 12 h, decreases in cellular levels of dATP, dCTP and dGTP by 50-90% over the same time course, and a two- to fourfold increase in the level of mRNA for both the M1 and M2 subunits of RR, at 24, but not between 1 and 4 h, which probably represents a response to the earlier decrease in RR activity. IFN at a clinically achievable concentration (500 U/ml) failed to augment the effects of HU on RR protein, RR mRNA levels or RR enzyme activity in either the wild-type or resistant cells, suggesting that the mechanism by which IFN augments the effects of HU in the wild-type cells is independent of the effects of HU on M2.

Base Sequence↗

PubMed1997

Is treatment with hydroxyurea leukemogenic in patients with essential thrombocythemia? An analysis of three new cases of leukaemic transformation and review of the literature.

From 1981 to 1995, we diagnosed, followed and treated at our institution fifty-eight cases of essential thrombocythemia (ET), using hydroxyurea (HU) as first-line therapy in these patients. Three patients who were continuously receiving HU had a leukemic transformation after a chronic phase of respectively 47, 81 and 90 months. One patient developed an acute leukemia with minimal myeloid differentiation (AML MO) and soon died of refractory disease; the second developed a refractory anemia with excess blasts in transformation (t-RAEB) and survived one year; the third patient developed a chronic myelomonocytic leukemia (CMML) and is alive at 21 months. The two former patients had complex nonrandom bone marrow karyotypic abnormalities, suggestive of therapy-related leukemia, whereas the latter one had a normal karyotype throughout the chronic and leukemic phase. These findings, together with recently published results on myeloproliferative disorders (MPD) treated with HU, suggest that this drug might be as leukemogenic as other myelosuppressive therapies in patients with ET. Longterm HU therapy should be reserved for patients in whom the treatment benefits obviously outweigh the risk of inducing leukemia.

Aged↗

PubMed2004

5-fluorouracil and hydroxyurea enhance adenovirus-mediated transgene expression in colon and hepatocellular carcinoma cells.

PURPOSE: To investigate the efficient transduction of tumor cells which remains a major limitation of cancer gene therapy. METHODS: In this study, we tested whether treatment with antimetabolic drugs 5-FU and hydroxyurea (HU) could improve adenovirus-mediated gene expression in tumor cells. RESULTS: We found that 5-FU and HU treatment significantly increased beta-gal activity in adenovirus (Ad.CMVBG)-infected human colon carcinoma (LoVo) and hepatocellular carcinoma (SMMC7721) cells in a dose- and time-dependent manner. These increases were maximized at 5.01+/-0.42-fold and 3.32+/-0.32-fold for 5-FU (50 microM), and at 6.60+/-0.50-fold and 4.82+/-0.43-fold for HU (5 mM) treatment, respectively, after 48 h infection. Transient increases in viral uptake, determined by real-time PCR for viral DNA content and by confocal microscopy for viral particles, were observed in 5-FU or HU-treated cells that partially contribute to the overall increases of beta-gal expression. Moreover, mRNA levels for the beta-gal gene in infected cells were significantly increased in both LoVo and SMMC7721 cells by 5-FU and HU treatment in contrast to the inhibition of viral DNA replication and the unchanged mRNA levels for alpha-actin gene. The induction appeared to be the result of enhanced transcription since beta-gal mRNA half-life was not affected by drug treatment. However, similar induction was not detected in CMV-beta-gal-expressing stable cells, suggesting that an adenovirus-associated mechanism might be involved in this induction. CONCLUSIONS: Our findings suggest that it may be possible to improve tumor cell transduction by adenovirus using chemotherapy.

Adenoviridae↗

PubMed2002

Tritrichomonas foetus: induced division synchrony by hydroxyurea.

Treatment of cultures of Tritrichomonas foetus with 4 mM hydroxyurea (HU), a known DNA synthesis inhibitor, induced pseudocyst formation and caused a mitotic burst. An hour after drug release there was a characteristic, synchronous burst of cell division. T. foetus culture was arrested in the G2/M phase. The synchrony index varied from 66% to 69%. The synchrony was maintained for several cell cycles, even in thawed cultures which had been frozen for storage in liquid nitrogen. The synchronized cells were analyzed by light and scanning electron microscopy, as well by flow cytometry.

Animals↗