Reversible ageusia after chemotherapy with pegylated liposomal doxorubicin

OBJECTIVE: To report a case of reversible ageusia in a patient with multiple myeloma receiving pegylated liposomal doxorubicin. CASE SUMMARY: A 67–year-old man with a history of arterial hypertension and persisting left bundle-branch block was diagnosed with multiple myeloma. He was initially treated with cyclophosphamide 200 mg/m2 (days 1–4), pegylated liposomal doxorubicin 20 mg/m2 (day 1), and dexamethasone 40 mg (days 1–4) (CLAD). That treatment was followed by high-dose melphalan therapy and autologous peripheral stem-cell transplantation. The disease recurred 18 months later, and renal failure developed. The patient was again treated with the CLAD protocol. After the first cycle, almost complete ageusia occurred, along with weight loss and severe depression. Chemotherapy was continued, but pegylated liposomal doxorubicin was replaced by conventional doxorubicin. Within 12 weeks, the patient's sense of taste returned to normal. DISCUSSION: Pegylated liposomal anthracyclines are increasingly being used as a less cardiotoxic alternative to conventional doxorubicin in first- and second-line therapy of multiple myeloma. Whereas cardiotoxicity and unspecific reactions are seen less frequently, palmar—plantar erythrodysesthesia is a common reaction to pegylated liposomal anthracyclines. No other reasons for ageusia in our patient could be identified. Based on the Naranjo probability scale, ageusia was rated as a probable reaction to pegylated liposomal doxorubicin. CONCLUSIONS: As with all new and innovative drugs, thorough documentation of infrequent adverse events is necessary. We would like to raise awareness for ageusia, which appears to be a rare but severely impairing adverse reaction to a relatively new pharmacologic agent.