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Various toxicities: case report An infant girl [exact age at reaction onset not stated] developed thrombocytopenia, anaemia, increased AST and increased ALT during treatment with cladribine and cytarabine. Additionally, she developed immune thrombocytopenia secondary to cladribine and experienced increased ALT level secondary to eltrombopag [routes and durations of treatments to reactions onset not stated; not all outcomes not stated]. The girl, at the age of 7 months was diagnosed with Langerhans Cell histiocytosis (LCH) and also had diet-related iron deficiency. Initially, she was treated with vinblastine and prednisolone as per the LCH-IV protocol with stratum 1. After initial improvement, a clinical and radiologic progression of the right temporal mass was noted. Hence, her treatment was switched to two 28-day cycles of cytarabine 500 mg/m2 twice a day for days 1–5 of each cycle and cladribine 0.3 mg/kg daily for days 2–6 of each cycle (stratum III salvage therapy). Thereafter, a significant response in LCH was noted. However, each cycle of cytarabine and cladribine chemotherapy was complicated by grade III anaemia, grade IV thrombocytopenia, grade III to IV increased ALT and grade I to III increased AST. During the third cycle of cytarabine and cladribine, her platelet count recovered. However, at day +39, her platelet count decreased below 10 × 109/L. No features of viral illness or clot or evidence of a platelet consumption process were observed. On day +41, bone marrow examination showed normal trilineage haematopoiesis, megakaryopoiesis and haemophagocytosis. Immune thrombocytopenia (IT) secondary to cladribine was considered. The girl underwent platelet transfusion and an increase in platelet count was noted. However, 29.5 hours after the transfusion, the platelet count again decreased to 9 × 109/L. She received IV immune globulin [immunoglobulin] 0.9 g/kg at day +41 and day +57, along with 14 days of oral prednisolone 40 mg/m2 from day +43, but the treatment was unsuccessful. During this time, she was 15-months-old and had started to walk independently. Due to a risk of acute haemorrhage, a second-line treatment with oral eltrombopag 1.1 mg/kg/d from day +72 along with a four day course of dexamethasone was initiated. Thereafter, her platelet count increased to above 150 × 109/L and remained stable. Only a grade I increased ALT was noted during the first month of eltrombopag therapy. Following resolution of IT, treatment with cytarabine and cladribine was restarted and eltrombopag was weaned off. Twelve months after discontinuation of eltrombopag, her platelet count continues to be stable. Author comment: "Cladribine, a purine nucleoside analogue, had been associated with IT". "Each cycle of cytarabine/cladribine chemotherapy was complicated by grade 3 anemia, grade 4 thrombocytopenia, grade 3 to 4 alanine aminotransferase increase and grade 1 to 3 aspartate aminotransferase increase" "There was only transient alanine aminotransferase increase (grade 1) in the first month of eltrombopag use, and no