Reactions 879 - 24 Nov 2001

SAntineoplastics

Idiopathic thrombocytopenic purpura: 3 casereports

Three men with acute lymphoblastic leukaemia developedidiopathic thrombocytopenic purpura during or aftertreatment with antineoplastics; all the men achieved completeremission of their disease.

The first man was aged 25 years when he started inductiontherapy with fractionated cyclophosphamide, vincristine,doxorubicin and dexamethasone (Hyper-CVAD) [dosages notstated]. He then received 8 courses of consolidation therapywith Hyper-CVAD alternating with high-dose methotrexateand cytarabine; CNS prophylaxis comprised intrathecalmethotrexate 12mg on day 2 and cytarabine 100mg on day 8.Maintenance therapy was then administered for 2 years, andconsisted of mercaptopurine, vincristine, methotrexate andprednisone (POMP) [dosages not stated]. Approximately 5years after starting antineoplastic therapy, and around 2.5years after completing maintenance therapy, he developedpurpura, and his platelet count was found to be 3 × 109/L. Abone marrow biopsy showed an increased megakaryocytecount. He was diagnosed with idiopathic thrombocytopenicpurpura and was treated with corticosteroids and high-dose IVimmunoglobulins. His platelet count increased onlytransiently. A splenectomy was performed, following whichhis platelet count normalised. No further treatment wasrequired during approximately 3 years of follow-up.

The second man was aged 27 years when he started 8courses of antineoplastic therapy with Hyper-CVAD, alongwith intrathecal methotrexate and cytarabine [dosages notstated]. About 6 months later, he started maintenance therapywith POMP [dosages not stated]. Approximately 17 monthslater, his platelet count was 20 × 109/L. A diagnosis ofidiopathic thrombocytopenic purpura was made. He wastreated with oral prednisone and, 3 months later, his plateletcount had increased to 50 × 109/L. At completion ofmaintenance therapy approximately 10 months later, hisplatelet count was 84 × 109/L.

The third man was aged 55 years when treatment with 8courses of Hyper-CVAD alternating with high-dosemethotrexate and cytarabine [dosages not stated] wasinitiated; he also received 2 intrathecal injections ofmethotrexate and cytarabine [doses not stated] with eachcourse of systemic therapy (a total of 16 injections).Approximately 5 months after he started antineoplastictherapy, 22 days after he completed his sixth course, hisplatelet count was 7 × 109/L. He was treated withcorticosteroids and high-dose immunoglobulin for presumedidiopathic thrombocytopenic purpura and his platelet countincreased to 73 × 109/L. Antineoplastic therapy was continuedas scheduled. At follow-up, approximately 13 months afterthrombocytopenia was first observed, his platelet count was125 × 109/L.

Author comment: ‘The occurrence of ITP [idiopathicthrombocytopenic purpura] following the successful treatmentof ALL [acute lymphoblastic leukaemia] with Hyper-CVADregimen raises the possibility that this dose-intensive regimenmay be responsible for immune disturbances which lead toautoimmune disorders such as ITP.’Tannir NM, et al. Idiopathic thrombocytopenic purpura following successfultreatment of acute lymphoblastic leukemia. Leukemia and Lymphoma 41: 217-220,Mar 2001 - USA 807205781

1

Reactions 24 Nov 2001 No. 8790114-9954/10/0879-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved