Hypomagnesemia, renal dysfunction, and Raynaud's phenomenon in patients treated with cisplatin, vinblastine, and bleomycin

Thirty men with metastatic germ cell cancer were treated with cisplatin (20 mg/m2 administered intravenously, days 1-5), vinblastine, and bleomycin at 3- to 4-week intervals for four to six courses. There was a sequential fall in serum magnesium (P less than 0.001) with each course of therapy: 26 of the 30 patients (87%) became hypomagnesemic, and the median magnesium nadir was 1.1 meq/l. No acute clinical effects of the hypomagnesemia were observed. The mean creatinine clearance declined from 115 ml/minute before therapy to 65 ml/minute, and the mean serum creatinine rose from 0.9 mg/dl to 1.6 mg/dl after six courses of therapy. With a minimum follow-up of 36 months, 13 of the patients (43%) have clinical evidence of Raynaud's phenomenon. Severity of prior hypomagnesemia predicted an increased risk of Raynaud's phenomenon. Renal dysfunction, hypomagnesemia, and Raynaud's phenomenon are common chronic toxicities of vinblastine, bleomycin, and cisplatin therapy.