Immune-mediated thrombocytopenia resulting from sensitivity to oxaliplatin.
Thrombocytopenia developing in the course of chemotherapy for malignant disease is usually attributed to drug-induced marrow suppression and/or marrow replacement by tumor. We describe two patients who developed severe thrombocytopenia and hemorrhagic symptoms while being treated with oxaliplatin, 5-fluorouracil, and leukovorin for metastatic colon cancer in whom platelet destruction appears to have been caused by oxaliplatin-dependent antibodies specific for the platelet glycoprotein IIb/IIIa complex (alpha(IIb)/beta(3) integrin). Drug-induced immune thrombocytopenia (DITP) should be considered in patients who experience a sudden, isolated drop in platelet levels while being treated with chemotherapeutic agents, especially when adequate numbers of megakaryocytes are present in the bone marrow.
Platelet & Neutrophil Immunology Laboratory, BloodCenter of Wisconsin, Milwaukee, 53201-2178, USA. brian.curtis@bcw.edu
Brian R
BR
Curtis
James
J
Kaliszewski
Marisa B
MB
Marques
M Wasif
MW
Saif
Lisle
L
Nabelle
Jules
J
Blank
Janice G
JG
McFarland
Richard H
RH
Aster
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D001323:Autoantibodies / Q000097:blood; D001854:Bone Marrow Cells / Q000378:metabolism / Q000473:pathology; D002277:Carcinoma / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D003110:Colonic Neoplasms / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008533:Megakaryocytes / Q000378:metabolism / Q000473:pathology; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects*; D000077150:Oxaliplatin; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000139:chemically induced*; D014803:Vitamin B Complex / Q000008:administration & dosage
D000970:Antineoplastic Agents; D001323:Autoantibodies; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D014803:Vitamin B Complex; D002955:Leucovorin; D005472:Fluorouracil