Concurrent thrombotic thrombocytopenic purpura and immune thrombocytopenic purpura in a patient with metastatic neuroendocrine tumour successfully treated with rituximab-CVP.
We report a case of concurrent thrombotic thrombocytopenic purpura (TTP) and immune thrombocytopenic purpura (ITP) in a 63-year-old woman who had been receiving treatment with bevacizumab for metastatic neuroendocrine tumour (NET). At diagnosis, she had severe anaemia and thrombocytopenia with elevated lactate dehydrogenase and many schistocytes on the peripheral blood smear. She was treated with frequent fresh frozen plasma infusions and plasmapheresis with poor response. Later, she was found to have platelet surface glycoprotein antibodies in the serum and received four cycles of rituximab, vincristine, cyclophosphamide (rituximab-CVP) and steroids in addition to plasma therapy. The haemoglobin and platelet counts improved. To our knowledge, this is the first reported case of concurrent TTP and ITP in a patient with metastatic NET diagnosed while receiving bevacizumab therapy, who was successfully treated with the combination of rituximab, vincristine, cyclophosphamide and steroids.
Department of Hematology/Oncology, MD Anderson Cancer Center, Houston, Texas, USA. sbayraktar@mdanderson.org
Soley
S
Bayraktar
Bernal
B
Eileen
Sherry
S
Shariatmadar
Eric
E
Lian
D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000068258:Bevacizumab; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000150:complications* / Q000188:drug therapy; D010951:Plasma Exchange; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications* / Q000188:drug therapy; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications* / Q000188:drug therapy; D000069283:Rituximab
D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D007155:Immunologic Factors; D000068258:Bevacizumab; D000069283:Rituximab