Stabilization of bone marrow infiltration by metastatic breast cancer with continuous doxorubicin.
Complete bone marrow infiltration with profound pancytopenia is very uncommon in breast cancer. Bone marrow metastasis can frequently occur following development of metastatic breast cancer. However, bone marrow failure as the herald of this disease is not typically seen. Very limited data exists as to the safest and most efficacious manner to treat patients with profound pancytopenia due to metastatic solid tumor involvement. In this case, the patient's thrombocytopenia was particularly worrisome, requiring daily platelet transfusions. There was also concern that cytotoxic chemotherapy would exacerbate the patient's thrombocytopenia and increase bleeding risk. The patient's dramatic response to chemotherapy with full platelet recovery is also highly unusual. For our patient, continuous doxorubicin successfully "unpacked" the bone marrow despite a low baseline platelet level, and without increasing the need for more frequent platelet transfusion or risk of catastrophic bleeding. Given the rarity of this presentation, it is currently unknown if the majority of similar patients experience near full recovery of hematopoietic function after initiation of appropriate systemic treatment for metastatic disease.
Northeast Ohio Medical University, College of Medicine, Rootstown, OH 44272, USA.
Gaurav
G
Pahouja
Breast Program, Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, USA.
Robert
R
Wesolowski
Breast Program, Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, USA.
Raquel
R
Reinbolt
Department of Pathology, Wexner Medical Center at The Ohio State University, USA.
Gary
G
Tozbikian
Breast Program, Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, USA.
Michael
M
Berger
Breast Program, Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, USA.
Neha
N
Mangini
Breast Program, Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, USA.
Maryam B
MB
Lustberg
Continuous; Doxorubicin; Metastatic breast cancer; Pancytopenia