Oxaliplatin-induced immune pancytopenia.
BACKGROUND
Oxaliplatin, a third-generation platinum compound, has been implicated in isolated cases of immune hemolytic anemia and/or immune thrombocytopenia. The first case of severe immune pancytopenia related to oxaliplatin is described.


METHODS
A 79-year-old woman with colorectal cancer was initially treated with 5-fluorouracil and she later received oxaliplatin and leucovorin every 2 to 4 weeks. During the 15th and 17th cycles of chemotherapy she developed thrombocytopenia, hemolysis, and neutropenia. No problems occurred during the 16th cycle without oxaliplatin. Serologic testing including detection of drug-dependent antibodies and autoantibodies was performed with standard techniques.


RESULTS
Serologic findings included a positive immunoglobulin G direct antiglobulin test; nonreactive red blood cell (RBC) eluates; platelet (PLT)-bound antibodies to glycophorin (GP) IIb-IIIa, GPIb-IX, and GPIa-IIa; and oxaliplatin-dependent antibodies to PLTs, RBCs, and neutrophils.


CONCLUSIONS
Oxaliplatin may lead to the production of ddabs to RBCs, PLTs, and neutrophils. Thus the risk of immune cytopenias should always be considered in patients treated with oxaliplatin.
Taleghani
Behrouz Mansouri
BM
Department of Hematology and Central Hematology Laboratory, Division of Transfusion Medicine, University Hospital, Inselspital, Bern, Switzerland.
Meyer
Oliver
O
Fontana
Stefano
S
Ahrens
Norbert
N
Novak
Urban
U
Borner
Markus M
MM
Salama
Abdulgabar
A
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D005260:Female; D006461:Hemolysis; D006801:Humans; D009503:Neutropenia / Q000139:chemically induced / Q000276:immunology; D009944:Organoplatinum Compounds / Q000009:adverse effects*; D000077150:Oxaliplatin; D010198:Pancytopenia / Q000139:chemically induced* / Q000276:immunology; D013921:Thrombocytopenia / Q000139:chemically induced / Q000276:immunology
D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin