Vemurafenib
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Agranulocytosis: case report A 38-year-old woman developed agranulocytosis during treatment with vemurafenib for hairy cell leukaemia (HCL). The woman, who presented to hospital with severe pancytopenia and splenomegaly, was diagnosed with a hairy cell leukaemia with BRAFV600E mutation in hairy cells. Owing to a severe ongoing genital infection, the size of her spleen and the depth of pancytopenia, and in order to prevent prolonged myelosuppression, purine-analogues were not recommended. She therefore started receiving vemurafenib 960mg twice daily [route not stated] and rituximab for a scheduled duration of 4 months. During admission, several skin rashes appeared, with diffuse maculopapular lesions but without pruritus, which resolved in 7–10 days. Vemurafenib was suspended 24 days following its initiation due to toxidermia and agranulocytosis. A bone marrow smear confirmed agranulocytosis [time to reaction onset not stated] and was induced by vemurafenib. Ten days following vemurafenib cessation, the woman showed a complete neutrophil recovery was noted. She did not require haematopoietic growth factors support. A bone marrow biopsy performed one month following the resolution of the aplasia revealed a good partial response in the HCL. She was also found to have an underlying systemic mastocytosis alongside hairy cell leukaemia. The maculopapular rash presented during vemurafenib treatment was attributed to multiple drugs allergies [details not stated] and concurrent systemic mastocytosis. Boileve A, et al. Mastocytosis onset in a patient with treated hairy cell leukemia: Just a coincidence? Blood Cells, Molecules and Diseases 81: Mar 2020. Available from: 803444780 URL: http://doi.org/10.1016/j.bcmd.2019.102392
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Reactions 11 Jan 2020 No. 1786
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