title: Development of pancytopenia with neutralizing antibodies to thrombopoietin after multicycle chemotherapy supported by megakaryocyte growth and development factor.
abstract: Clinical trials of thrombopoietin (TPO), the central regulator of megakaryocytopoiesis, have revealed few side effects associated with its use. We here report a case of pancytopenia associated with the development of neutralizing antibodies to TPO that occurred in a patient who had undergone multicycle chemotherapy with multiple cycles of subcutaneous administration of pegylated recombinant human megakaryocyte growth and development factor. Samples of the patient's bone marrow showed trilineage hypoplasia with absence of myeloid, erythroid, and megakaryocyte progenitor cells but with elevated endogenous levels of erythropoietin, granulocyte colony-stimulating factor, and stem-cell factor. To our knowledge, this is the first report of an aplastic anemia-like syndrome associated with neutralizing antibodies to TPO.
authors.affiliation: Centre for Developmental Cancer Therapeutics, Department of Haematology and Medical Oncology, Ludwig Institute for Cancer Research, Royal Melbourne Hospital, 45 Poplar Road, Parkville, Victoria 3052, Australia. russell_basser@csl.com.au
authors.forename: Russell L
authors.initials: RL
authors.lastname: Basser
authors.forename: Elizabeth
authors.initials: E
authors.lastname: O'Flaherty
authors.forename: Michael
authors.initials: M
authors.lastname: Green
authors.forename: Maria
authors.initials: M
authors.lastname: Edmonds
authors.forename: Janet
authors.initials: J
authors.lastname: Nichol
authors.forename: Dora M
authors.initials: DM
authors.lastname: Menchaca
authors.forename: Brian
authors.initials: B
authors.lastname: Cohen
authors.forename: C Glenn
authors.initials: CG
authors.lastname: Begley
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001323:Autoantibodies / Q000097:blood*; D003115:Colony-Stimulating Factors / Q000097:blood; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology; D010198:Pancytopenia / Q000139:chemically induced*; D011994:Recombinant Proteins / Q000009:adverse effects; D013926:Thrombopoietin / Q000009:adverse effects* / Q000276:immunology*
chemical_list: D001323:Autoantibodies; D003115:Colony-Stimulating Factors; D011994:Recombinant Proteins; D013926:Thrombopoietin