Alectinib
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Anisopoikilocytosis and haemolysis: 2 case reports In a case series, a 66-year-old man and a 77-year-old woman were described, who developed anisopoikilocytosis and haemolysis following treatment with alectinib for non-small cell lung carcinoma [route and outcomes not stated; not all dosages stated]. Case 1; The 66-year-old man, who had metastatic non-small cell lung carcinoma with brain metastasis, started receiving alectinib. His baseline haemoglobin (Hb) concentration was 115g/L and mean corpuscular volume (MCV) of 62fl. After 1 month of initiation of alectinib, his Hb count decreased to 80g/L. Additionally, his haemolytic markers including unconjugated bilirubin (31 µmol/L), lactate dehydrogenase (758 units/L), haptoglobin (0.04g/L) and reticulocyte count (140X109/L) were noted to be abnormal. His blood film showed marked fragmentation and marked anisopoikilocytosis with irregularly contracted cells, acanthocytes, microspherocytes and polychromasia. He also had a history of microcytosis and basophilic stippling due to β-thalassaemia trait. After 2 week, at follow-up, his haemolytic parameters improved, but persistent morphological changes were noted. Therefore, alectinib was discontinued. Case 2: The 77-year-old woman, who had a nodal, pulmonary and pleural disease, started receiving alectinib 600mg twice daily. After 3 month of initiation of alectinib, her haemoglobin (Hb) count was decreased from 115g/L to 93g/L with evidence of haemolysis including unconjugated bilirubin of 93 µmol/L, lactate dehydrogenase 322 units/L, haptoglobin 0.97g/L, reticulocyte count 100X109/L. The blood film showed marked spheroacanthocytosis. Additionally, she was found to have minimal red cell fragmentation. Therefore, alectinib was discontinued. After 2 weeks of discontinuation of alectinib, the unconjugated bilirubin normalised to 12 µmol/L and her Hb was stable at 90g/L. Her treatment with alectinib was reinitiated with a reduced dose of 450mg twice daily. Yuan Y, et al. Two cases of marked red cell anisopoikilocytosis and haemolysis with alectinib, an anaplastic lymphoma kinase inhibitor. British Journal of Haematology 190: 803507731 642, No. 5, Sep 2020. Available from: URL: http://doi.org/10.1111/bjh.16813
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Reactions 17 Oct 2020 No. 1826
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