A Rare Case Report of Acute Coronary Syndrome Following Vincristine Administration in a Newly Diagnosed Acute Lymphoblastic Leukemia in a Young Female Patient

Case DesCriptionA 38-year-old premenopausal woman, BMI 21.4 kg/m 2 , with recently diagnosed type 2 diabetes mellitus, presented with generalized fatigue, undocumented fever, headache, and double vision.She had no cardiac risk factors, including obesity, hypertension, smoking, alcohol use, oral contraceptive use, or a family history of cardiovascular disease.Initial blood tests revealed hemoglobin (Hb) 6.1 gm/dL, total white blood cell (WBC) count of 2,43,470 cells/mm 3 , introDuCtion Many conventional cytotoxic chemotherapies (ChT) and newer antineoplastic agents, such as tyrosine kinase inhibitors (TKIs), monoclonal antibodies against vascular endothelial growth factor (VEGF) or human epidermal growth factor receptor 2 (HER2), immunotherapy, and chimeric antigen receptor (CAR) T cell therapy, have been linked to a range of cardiovascular side effects, including hypertension, arrhythmias, ischemic heart disease, myocarditis, dilated cardiomyopathy, and thrombosis.These side effects, varying from mild to life-threatening, can significantly impact survival and quality of life, necessitating early diagnosis, continuous monitoring, and, when necessary, treatment adjustments.Cardiotoxicity, par ticularly with anthracyclines and alkylating agents like doxorubicin, daunorubicin, epirubicin, cyclophosphamide, ifosfamide, and melphalan, is the most studied toxicity, often leading to irreversible left ventricular (LV) dysfunction. 1 In contrast, anti-HER2 and anti-VEGF drugs, immunotherapy, and TKIs are associated with reversible cardiovascular issues such as hypertension, reversible LV dysfunction, and thrombosis.Vascular toxicity, often resulting from endothelial damage, is frequently observed with 5-fluorouracil, capecitabine, and VEGF inhibitors.Vincristine, primarily known for peripheral neuropathy and gastrointestinal (GI) distress, has been implicated in rare cardiovascular events, such as myocardial ischemia and infarction, though causation remains uncertain. [2]3][4][5] Herein we report a case of Philadelphia chromosome (Ph)-positive B cell acute lymphoblastic leukemia (ALL) on induction ChT (MCP 841 protocol) who developed vincristine-induced acute coronary syndrome (ACS).