title: A rare hematological adverse event induced by bevacizumab: severe thrombocytopenia.
abstract: BACKGROUND
  Bevacizumab, a monoclonal antibody to vascular endothelial growth factor-A, is approved for the treatment of various malignancies, and its hematological toxicities are considered infrequent.
  
  
  METHODS
  A colorectal cancer patient receiving chemotherapy (5-fluorouracil and oxaliplatin) plus bevacizumab developed acute, severe thrombocytopenia. We postulated that this thrombocytopenia could be directly triggered by bevacizumab.
  
  
  RESULTS
  A man with stage IV colorectal cancer and synchronous liver metastasis had received 10 cycles of FOLFOX plus bevacizumab (5 mg/kg) without significant hematological toxicity. Due to thrombocytopenia, oxaliplatin was withdrawn after cycle 11. On cycle 12, shortly after bevacizumab infusion and before 5-fluorouracil infusion, the patient developed fever, lower limbs purpura, grade 1 proctorrhagia, and epistaxis. Platelets had decreased from 105,000/mm(3) to 3000/mm(3) within 1 hour after bevacizumab infusion. Flow cytometry identified platelet-associated immunoglobulins. Despite 2 apheresis-derived platelet transfusions, oral corticotherapy, and gamma globulin infusions, thrombocytopenia persisted, but was finally successfully treated with a peptibody thrombopoietin mimetic, which was introduced 28 days after the last bevacizumab infusion.
  
  
  CONCLUSIONS
  Clinicians should keep in mind that bevacizumab can induce acute and potentially severe immune-mediated thrombocytopenia.
authors: Department of Gastroenterology, Cochin Teaching Hospital, Assistance publique-Hôpitaux de Paris, Paris, France.
authors: Marie
authors: M
authors: Dior
authors: Romain
authors: R
authors: Coriat
authors: Olivier
authors: O
authors: Mir
authors: Catherine
authors: C
authors: Brezault
authors: Géraldine
authors: G
authors: Perkins
authors: Marion
authors: M
authors: Dhooge
authors: François
authors: F
authors: Goldwasser
authors: Stanislas
authors: S
authors: Chaussade
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000068258:Bevacizumab; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage / Q000009:adverse effects; D008113:Liver Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000556:secondary; D008297:Male; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects; D000077150:Oxaliplatin; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy; D035583:Rare Diseases; D011961:Receptors, Fc / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D013926:Thrombopoietin / Q000627:therapeutic use
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D009944:Organoplatinum Compounds; D011961:Receptors, Fc; D011993:Recombinant Fusion Proteins; D000077150:Oxaliplatin; D000068258:Bevacizumab; D013926:Thrombopoietin; C488777:romiplostim; D002955:Leucovorin; D005472:Fluorouracil