Oxaliplatin
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Thrombotic thrombocytopenic purpura in an elderly patient: case report A 68-year-old woman developed thrombotic thrombocytopenic purpura (TTP) during treatment with oxaliplatin as part of chemotherapy for metastatic colon cancer. The woman, who had a history of hypertension, was diagnosed with rectal adenocarcinoma with liver metastasis in February 2008. She was started on a chemotherapeutic regimen consisting of infusional fluorouracil, oxaliplatin [dosage not stated] and folinic acid [leucovorin] (FOLFOX regimen) with bevacizumab. She did not experience complications and underwent an anterior peritoneal resection with loop ileostomy after four cycles. Afterwards, she received more cycles of FOLFOX and bevacizumab until February 2009. She was diagnosed with lung metastases following a partial hepatectomy for resection of her liver lesion. Her chemotherapy was switched to fluorouracil, irinotecan and folinic acid with bevacizumab. She underwent cryotherapy for liver and lung nodules, but she had pulmonary and hepatic disease progression. FOLFOX was restarted. Of note, her last oxaliplatin exposure had occurred 2 years earlier. On day 1 of cycle two, after approximately half of her dose of oxaliplatin had been infused, she developed sudden-onset chest pain [duration of treatment to reaction onset not clearly stated]. The oxaliplatin infusion was withdrawn, and the woman was transferred to an emergency room. She experienced chest pain relief with aspirin and nitroglycerin. Her temperature and BP were 98.8°F and 185/88 mm Hg, respectively. She was hospitalised, and she developed confusion. She also had bleeding from her ileostomy that ceased upon application of direct pressure. During her hospital stay, she also developed jaundice, anaemia, severe thrombocytopenia, and haemolysis. She was diagnosed with TTP. She was treated with prednisone and plasma exchange sessions. In the ensuing days, her haemoglobin level stabilised and her platelet count improved. She no longer had clinical evidence of haemolysis. She underwent haemodialysis sessions, and her creatinine level improved. Of note, she had received a cumulative oxaliplatin dose of 850 mg/m2. Author comment: "Here we report a case of oxaliplatininduced classic TTP". Niu J, et al. Oxaliplatin-induced thrombotic thrombocytopenic purpura: Case report and literature review. Journal of Clinical Oncology 30: e312-e314, No. 31, Nov 2012. Available from: URL: http://dx.doi.org/10.1200/JCO.2012.42.5082 803081838 USA
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Reactions 12 Jan 2013 No. 1434
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