Antineoplastics
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Reactions 879 - 24 Nov 2001 S Antineoplastics Idiopathic thrombocytopenic purpura: 3 case reports Three men with acute lymphoblastic leukaemia developed idiopathic thrombocytopenic purpura during or after treatment with antineoplastics; all the men achieved complete remission of their disease. The first man was aged 25 years when he started induction therapy with fractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone (Hyper-CVAD) [dosages not stated]. He then received 8 courses of consolidation therapy with Hyper-CVAD alternating with high-dose methotrexate and cytarabine; CNS prophylaxis comprised intrathecal methotrexate 12mg on day 2 and cytarabine 100mg on day 8. Maintenance therapy was then administered for 2 years, and consisted of mercaptopurine, vincristine, methotrexate and prednisone (POMP) [dosages not stated]. Approximately 5 years after starting antineoplastic therapy, and around 2.5 years after completing maintenance therapy, he developed purpura, and his platelet count was found to be 3 × 10 9 /L. A bone marrow biopsy showed an increased megakaryocyte count. He was diagnosed with idiopathic thrombocytopenic purpura and was treated with corticosteroids and high-dose IV immunoglobulins. His platelet count increased only transiently. A splenectomy was performed, following which his platelet count normalised. No further treatment was required during approximately 3 years of follow-up. The second man was aged 27 years when he started 8 courses of antineoplastic therapy with Hyper-CVAD, along with intrathecal methotrexate and cytarabine [dosages not stated]. About 6 months later, he started maintenance therapy with POMP [dosages not stated]. Approximately 17 months later, his platelet count was 20 × 10 9 /L. A diagnosis of idiopathic thrombocytopenic purpura was made. He was treated with oral prednisone and, 3 months later, his platelet count had increased to 50 × 10 9 /L. At completion of maintenance therapy approximately 10 months later, his platelet count was 84 × 10 9 /L. The third man was aged 55 years when treatment with 8 courses of Hyper-CVAD alternating with high-dose methotrexate and cytarabine [dosages not stated] was initiated; he also received 2 intrathecal injections of methotrexate and cytarabine [doses not stated] with each course of systemic therapy (a total of 16 injections). Approximately 5 months after he started antineoplastic therapy, 22 days after he completed his sixth course, his platelet count was 7 × 10 9 /L. He was treated with corticosteroids and high-dose immunoglobulin for presumed idiopathic thrombocytopenic purpura and his platelet count increased to 73 × 10 9 /L. Antineoplastic therapy was continued as scheduled. At follow-up, approximately 13 months after thrombocytopenia was first observed, his platelet count was 125 × 10 9 /L. Author comment: ‘The occurrence of ITP [idiopathic thrombocytopenic purpura] following the successful treatment of ALL [acute lymphoblastic leukaemia] with Hyper-CVAD regimen raises the possibility that this dose-intensive regimen may be responsible for immune disturbances which lead to autoimmune disorders such as ITP.’ Tannir NM, et al. Idiopathic thrombocytopenic purpura following successful treatment of acute lymphoblastic leukemia. Leukemia and Lymphoma 41: 217-220, Mar 2001 - USA 807205781 1 Reactions 24 Nov 2001 No. 879 0114-9954/10/0879-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
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
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Reactions 24 Nov 2001 No. 8790114-9954/10/0879-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
