Temozolomide
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Pancytopenia in a patient with vitamin B12 deficiency?: case report A 22-year-old woman developed pancytopenia while receiving temozolomide for glioblastoma. She was subsequently found to have vitamin B12 deficiency. The woman, who had undergone surgery and radiotherapy, was found to have a residual mass on followup MRI. She commenced temozolomide 150 mg/m2 on days 1 to 5 every 4 weeks [route not stated]. For her second cycle, the dosage was increased to 200 mg/m2. After receiving six cycles, she presented with an abscess. Analysis revealed decreased levels of haemoglobin, WBCs, platelets and reticulocytes. She also had a mean corpuscular volume of 100fl. She was diagnosed with thrombocytopenia, thought to be caused by temozolomide-induced myelosuppression. Temozolomide was withdrawn for 2 weeks; however, the woman’s complete blood count values did not improve. A peripheral blood smear showed oval macrocytosis and hypersegmented granulocytes and results of a bone marrow examination were consistent with megaloblastic changes. As her serum vitamin B12 levels were low (100 pg/mL), she received therapy with IM vitamin B12 injections. Five days after completing vitamin B12 therapy, her reticulocyte count increased. Monthly treatment with vitamin B12 was recommended. Her vitamin B12 level subsequently increased to 986 pg/mL. Author comment: "[O]ther etiological factors such as dietary factors may also cause pancytopenia in patients receiving chemotherapy." Pehlivan Y, et al. Another cause of pancytopenia in a patient receiving temozolomide. Medical Principles and Practice 20: 377-379, No. 4, May 2011. 803056327 Available from: URL: http://dx.doi.org/10.1159/000324800 - Turkey
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Reactions 2 Jul 2011 No. 1358
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