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Myelosuppression and leucopenia: case report An 8-year-old girl developed myelosuppression and leucopenia during treatment with methotrexate and mercaptopurine for acute lymphoblastic leukaemia (ALL). The girl was hospitalised and diagnosed with ALL following investigations. She started receiving oral mercaptopurine [6-mercaptopurine] 50 mg/m2 daily and IM methotrexate 20 mg/m2/day once weekly [sic]. Concurrently, she also received various other medications. On week 9, a routine blood tests showed decreased WBCs, decreased haemoglobin, elevated C-reactive protein (CRP) and increased body temperature. From week 13, grade III leucopenia was noted, and therefore, it was monitored frequently. She was diagnosed with a myelosuppression secondary to methotrexate and mercaptopurine. Further, she developed infection due to myelosuppression. The girl started receiving cefoperazone/sulbactam [cefoperazone sodium/sulbactam sodium] 0.95g and 5% glucose injection with continuation of chemotherapy. She also received blood transfusion for recovery of haemoglobin. By week 14, her leucopenia reached to grade IV, and the CRP was 61.09 mg/L. Subsequently, her chemotherapy was stopped and vancomycin 250mg for the infection and 0.9% sodium chloride injection were initiated. She also received deoxyribonucleotide [sic.] to increase haemogram. Despite two weeks of anti-infective therapy, the infection was not controlled, indicating lack of efficacy to vancomycin and cefoperazone/sulbactam. Her WBC continued to decrease. Pharmacogenetic testing showed pre-existing homozygous gene mutation, which had high risk of leukopenia. Two weeks later, her blood routine count returned to normal, and no other abnormality was found. From week 16, the girl’s chemotherapy was restarted with decrease in the dose of mercaptopurine (i.e. adjusted to 10%–25% of the normal dose). Her other therapies were continued. Eventually, she was discharged and advised to keep warm to prevent cold and keep the living environment clean and sanitary to prevent infection. Ren D, et al. Analysis of one case of adverse drug reactions by mercaptopurine in the treatment of children with serious leukopenia induced by acute lymphocytic leukemia. [Chinese]. Pharmaceutical Care and Research 20: 77-79, No. 1, Feb 2020. Available from: URL: http://doi.org/10.5428/pcar20200122 [Chinese; summarised from a 803519997 translation]

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Reactions 12 Dec 2020 No. 1834