RESUMEN
Thrombocytopenia is often caused by myelosuppression during chemotherapy. However, when platelet transfusions are required, pathological conditions such as idiopathic thrombocytopenic purpura(ITP)and thrombotic thrombocytopenic purpura( TTP)also occur. We report a case of Merkel cell carcinoma complicated with severe thrombocytopenia treated with carboplatin/etoposide regimen after surgery. The patient's platelet count did not increase in spite of platelet transfusions. However, the platelet count increased after steroid treatment was chosen under the diagnosis of ITP. Subsequent examinations revealed that the patient had HLA antibody, which caused the platelet transfusion refractoriness. When the platelet count does not increase in spite of platelet transfusions during chemotherapy, the possibility that the platelet transfusion refractoriness is due to the presence of HLA antibody should be considered.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carboplatino/efectos adversos , Carcinoma de Células de Merkel/tratamiento farmacológico , Etopósido/efectos adversos , Neoplasias Cutáneas/tratamiento farmacológico , Trombocitopenia/terapia , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carboplatino/administración & dosificación , Carcinoma de Células de Merkel/cirugía , Etopósido/administración & dosificación , Femenino , Antígenos HLA/inmunología , Humanos , Transfusión de Plaquetas , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Trombocitopenia/inducido químicamenteRESUMEN
Recently, newer agents in regimens such as FOLFIRINOX have shown promising activity, being superior to gemcitabine as a single agent for unresectable pancreatic cancer patients with good performance status. Herein, we report a case of pancreatic cancer treated with the FOLFIRINOX regimen and pegfilgrastim prophylaxis as second-line treatment in a patient who failed this regimen. He previously received gemcitabine/nab-paclitaxel combination chemotherapy as first-line treatment. It was reported that grade 3-4 neutropenia frequently occurred in many patients receiving the FOLFIRINOX regimen. Prophylactic use of pegfilgrastim is recommended for cancer patients who are at high risk of neutropenic events. However, severe neutropenia occurred with the FOLFIRINOX regimen in spite of pegfilgrastim prophylaxis. We emphasize the importance of occasional serious adverse effects with the FOLFIRINOX regimen and pegfilgrastim prophylaxis.