Temozolomide
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Aplastic anaemia in a patient receiving radiotherapy: case report A 63-year-old woman developed aplastic anaemia while receiving temozolomide therapy with concurrent radiotherapy. The woman began receiving treatment with temozolomide [dosage and route not stated] and radiotherapy following diagnosis with glioblastoma. After receiving 18 of 42 days of temozolomide treatment and 15 of 22 fractions of radiotherapy, her blood analysis revealed significant decreases in WBCs (0.3 × 109/L), haemoglobin (88 g/L), neutrophils (0.1 × 109/L) and platelets (30 × 109/L). She reported urinary urgency, frequency and dysuria. Temozolomide was discontinued and the woman received antibiotics for her urinary tract infection. Three days later, further blood analysis revealed persistent pancytopenia. She received a transfusion of 10 units of platelets and 2 units of packed RBCs. She developed a fever, fatigue, dysphagia and thrush. She received ciprofloxacin and completed her scheduled course of radiotherapy. Her condition continued to deteriorate and she was hospitalised 2 days later with persistent pancytopenia, headache, febrile neutropenia, thrush and possible herpes simplex virus stomatitis. She received broad-spectrum antibiotics. Results of a bone marrow aspirate were suggestive of a hypoplastic or aplastic cause of pancytopenia. She required a 4-week hospital stay to treat her persistent pancytopenia, during which she received erythropoietin and filgrastim. Her WBC and neutrophil levels showed improvement; however, she continued to require transfusions of packed RBCs and platelets. Author comment: "In light of the temporal sequence of events, and in the absence of any other prescription medications known to cause this syndrome, the most likely cause of this patient’s aplastic anemia was [temozolomide]." Oh J, et al. Aplastic anemia with concurrent temozolomide treatment in a patient with glioblastoma multiforme. Current Oncology 17: 124-126, No. 4, 2010 803046702 Canada
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Reactions 8 Jan 2011 No. 1333
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