Sorafenib
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Bone marrow depression and peripheral blood cytopenias: 2 case reports Two male patients with relapsed acute myeloid leukaemia (AML) developed bone marrow depression and peripheral blood cytopenias while receiving treatment with sorafenib. One of the men later died. A 48-year-old man developed a relapse of AML 4 months after achieving complete molecular remission. After salvage therapy with high dose cytarabine and etoposide, bone marrow aspirate revealed 100% leukaemic blasts and 10–20% cellularity. He commenced receiving compassionate-use oral sorafenib 400mg twice daily. Within 15 hours of starting sorafenib, he had clearance of peripheral blood blasts. He was platelet transfusiondependent and a bone marrow aspirate revealed 5% cellularity, with no residual AML morphology. Two weeks later, he underwent a stem cell transplant and sorafenib was withdrawn. Due to complications of the transplantation, he later died. Autopsy showed no morphological signs of an AML relapse. A 68-year-old man developed relapsed AML 3 months after achieving complete remission. His bone marrow had 30% cellularity, with 10% leukaemic blasts. Due to his chronic renal dysfunction and cardiomyopathy, treatment with chemotherapy or allogeneic transplantation was not possible. He started receiving oral sorafenib 400mg twice daily. One month later, he had no residual acute leukaemia and 5% bone marrow cellularity. He was platelet transfusion dependent and his absolute neutrophil count was 120 cells/µL. The hypocellularity and cytopenia were thought to be sorafenib-induced and his oral dose was reduced to 200mg twice daily [patient outcome not stated]. Fesler MJ. Marked bone marrow hypoplasia associated with sorafenib-induced marrow blast clearance in two patients with FLT3-ITD acute myeloid leukemia. Leukemia Research 35: e21-e22, No. 3, Mar 2011. Available from: URL: http:// 803052689 dx.doi.org/10.1016/j.leukres.2010.10.028 - USA
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Reactions 16 Apr 2011 No. 1347
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