title: [Successful Management by Immunoglobulin for Sunitinib-Induced Thrombocytopenia in a Patient with Advanced Metastatic Renal Cell Carcinoma].
abstract: An 81-year-old man was referred to our hospital because of a right renal tumor with vena cava thrombus and multiple lung metastases that were detected by computed tomography (CT) scan during evaluation of respiratory discomfort. We started medical treatment with sunitinib at a dose of 50 mg daily in a 2-week-on, 1-week-off schedule after confirming clear cell renal cell carcinoma by tumor biopsy. After 2-week sunitinib treatment, thrombocytopenia continued and platelet count decreased to 1.8×10(9)/l at day 11 after stopping sunitinib. We needed to administer a total of 60 units platelet transfusion because of persistent thrombocytopenia. Bone marrow aspiration did not reveal myelosuppression or carcinoma invasion to bone marrow. Under the clinical diagnosis of drug-induced thrombocytopenia secondary to sunitinib, we started immunoglobulin therapy at day 23 after stopping sunitinib. Platelet count returned to normal 10 days after starting immunoglobulin. The patient developed exacerbating lung metastasis and carcinomatous lymphangiosis during subsequent course and died of renal cell carcinoma 79 days after starting sunitinib. Thrombocytopenia after sunitinib therapy is often encountered but prolonged thrombocytopenia is rare after stopping sunitinib. This case suggests that immunoglobulin therapy is effective for drug-induced prolonged thrombocytopenia through immunological mechanism.
authors.affiliation: The Department of Renal and Urologic Surgery, Asahikawa Medical University.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okazaki
authors.affiliation: The Department of Renal and Urologic Surgery, Asahikawa Medical University.
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Hori
authors.affiliation: The Department of Renal and Urologic Surgery, Asahikawa Medical University.
authors.forename: Masaki
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: The Department of Renal and Urologic Surgery, Asahikawa Medical University.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Hashizume
authors.affiliation: The Department of Renal and Urologic Surgery, Asahikawa Medical University.
authors.forename: Shin
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: The Department of Renal and Urologic Surgery, Asahikawa Medical University.
authors.forename: Makoto
authors.initials: M
authors.lastname: Azumi
authors.affiliation: The Department of Renal and Urologic Surgery, Asahikawa Medical University.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kita
authors.affiliation: The Department of Renal and Urologic Surgery, Asahikawa Medical University.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Iwata
authors.affiliation: The Department of Renal and Urologic Surgery, Asahikawa Medical University.
authors.forename: Seiji
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: The Department of Renal and Urologic Surgery, Asahikawa Medical University.
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Kakizaki
mesh_terms: D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy; D002292:Carcinoma, Renal Cell / Q000188:drug therapy*; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D007211:Indoles / Q000009:adverse effects* / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D011758:Pyrroles / Q000009:adverse effects* / Q000627:therapeutic use; D000077210:Sunitinib; D013921:Thrombocytopenia / Q000139:chemically induced / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents; D007136:Immunoglobulins; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib