Antineoplastics
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Reactions 1409 - 7 Jul 2012 S Antineoplastics Transfusion-refractory thrombocytopenia, treated with romiplostim: case report A 50-year-old woman with acute myeloid leukaemia (AML) developed transfusion-refractory thrombocytopenia after receiving treatment with antineoplastics [routes not stated]. Her condition improved after treatment with romiplostim [Nplate]; however, she later died. The woman received induction chemotherapy with cytarabine 100 mg/m 2 on days 1–7 and idarubicin 12 mg/m 2 on days 1–3. She developed cytarabine-induced hypersensitivity pneumonitis and chemotherapy-induced pancytopenia for 25 days [time to onset not stated]. The woman received transfusions of RBCs and platelets; however, she became refractory to platelet transfusions, with platelet counts rarely reaching 10 × 10 9 /L. Her course was then complicated by inflammatory panniculitis, febrile neutropenia and pancolitis. Her condition improved with supportive care, and she was discharged after 2 months’ hospitalisation. A bone marrow biopsy subsequently revealed refractory leukaemia, and she received a second induction chemotherapy with mitoxantrone 10 mg/m 2 on days 1–5 and etoposide 100 mg/m 2 on days 1-5. On day 7, she developed pancytopenia, with critical platelet counts despite repeated transfusions. Treatment with immune globulin was withdrawn after she developed fever and laryngospasm. On day 9, she developed febrile neutropenia, which was treated with tobramycin and piperacillin/tazobactam. On day 14, Klebsiella pneumoniae septicaemia was recorded, and she developed haemoptysis and petechiae on her lower limbs and soft palate. Despite frequent platelet transfusions, her platelet count on day 15 was 1 × 10 9 /L. On day 17, the woman received a single dose of SC romiplostim 60µg (1 µg/kg). She subsequently had no further episodes of bleeding and received no more platelet transfusions. Her petechiae gradually resolved and her platelet count increased. Her neutrophil count remained low. She then received pipobroman and gemtuzumab ozogamicin; however she died a few days later [cause of death not stated]. Author comment: "We report on the use of romiplostim in an AML patient with severe chemotherapy-induced symptomatic thrombocytopenia and severe refractoriness to [platelet] transfusions." Berthelot-Richer M, et al. Romiplostim efficacy in an acute myeloid leukemia patient with transfusion refractory thrombocytopenia. Transfusion 52: 739-741, No. 4, Apr 2012. Available from: URL: http://dx.doi.org/10.1111/ j.1537-2995.2011.03382.x - Canada 803072960 1 Reactions 7 Jul 2012 No. 1409 0114-9954/10/1409-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 1409 - 7 Jul 2012
SAntineoplastics
Transfusion-refractory thrombocytopenia, treatedwith romiplostim: case report
A 50-year-old woman with acute myeloid leukaemia(AML) developed transfusion-refractory thrombocytopeniaafter receiving treatment with antineoplastics [routes notstated]. Her condition improved after treatment withromiplostim [Nplate]; however, she later died.
The woman received induction chemotherapy withcytarabine 100 mg/m2 on days 1–7 and idarubicin12 mg/m2 on days 1–3. She developed cytarabine-inducedhypersensitivity pneumonitis and chemotherapy-inducedpancytopenia for 25 days [time to onset not stated].
The woman received transfusions of RBCs and platelets;however, she became refractory to platelet transfusions,with platelet counts rarely reaching 10 × 109/L. Her coursewas then complicated by inflammatory panniculitis, febrileneutropenia and pancolitis. Her condition improved withsupportive care, and she was discharged after 2 months’hospitalisation. A bone marrow biopsy subsequentlyrevealed refractory leukaemia, and she received a secondinduction chemotherapy with mitoxantrone 10 mg/m2 ondays 1–5 and etoposide 100 mg/m2 on days 1-5. On day 7,she developed pancytopenia, with critical platelet countsdespite repeated transfusions. Treatment with immuneglobulin was withdrawn after she developed fever andlaryngospasm. On day 9, she developed febrileneutropenia, which was treated with tobramycin andpiperacillin/tazobactam. On day 14, Klebsiella pneumoniaesepticaemia was recorded, and she developed haemoptysisand petechiae on her lower limbs and soft palate. Despitefrequent platelet transfusions, her platelet count onday 15 was 1 × 109/L. On day 17, the woman received asingle dose of SC romiplostim 60µg (1 µg/kg). Shesubsequently had no further episodes of bleeding andreceived no more platelet transfusions. Her petechiaegradually resolved and her platelet count increased. Herneutrophil count remained low. She then receivedpipobroman and gemtuzumab ozogamicin; however shedied a few days later [cause of death not stated].
Author comment: "We report on the use of romiplostimin an AML patient with severe chemotherapy-inducedsymptomatic thrombocytopenia and severe refractoriness to[platelet] transfusions."Berthelot-Richer M, et al. Romiplostim efficacy in an acute myeloid leukemiapatient with transfusion refractory thrombocytopenia. Transfusion 52: 739-741, No.4, Apr 2012. Available from: URL: http://dx.doi.org/10.1111/j.1537-2995.2011.03382.x - Canada 803072960
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Reactions 7 Jul 2012 No. 14090114-9954/10/1409-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
