Acquired amegakaryocytic thrombocytopenic purpura induced by percutaneous ethanol injection during treatment of hepatocellular carcinoma: A case report

ObjectiveThe aim of the study was to assess the effectiveness and safety of a combined therapy with transcatheter arterial chemoembolization (TACE) and FOLFOX4, in patients with unresectable advanced hepatocellular carcinoma (HCC).MethodsIn this study, patients with advanced HCC, that received treatment between November 2015 and October 2017, were recruited. Among these, 30 patients were treated with TACE only (TACE group); whereas 33 patients were treated with a combination of FOLFOX4 chemotherapy and TACE (combination group). Survival analyses, including overall survival (OS) and progression free survival (PFS) analysis, were performed for both groups. Following this, the responses of patients to treatment were evaluated every 3 months, and the toxic and adverse events were observed.ResultsThe median follow-up time was 9.2 months (3-36 months). In the combination group, at 3 months, a disease control rate (DCR) of 60.6%, and a median OS of 9.1 months was obtained [95% confidence interval (CI) 6.5-11.7]. In the TACE group, the DCR and OS were 33.3% and 5.5 months (95% CI 4.3-6.7), respectively. On the other hand, the PFS in the combination and TACE groups were observed as 5.6 months (95% CI 3.6-7.6) and 2.6 months (95% CI 2.0-3.2), respectively. Both these findings indicate a statistically significant difference (P = 0.01) between both the groups. Similar TACE associated adverse events were observed in both groups. In the combination group, frequently observed FOLFOX4 related adverse effects included nausea (90.9%), leukopenia (75.8%), thrombocytopenia (69.7%), and vomiting (69.7%). Most adverse reactions were between grades I-III and were alleviated after symptomatic treatments.ConclusionThe combination of TACE with FOLFOX4 therapy has better effectivity and safety than TACE alone.

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Combination of TACE and FOLFOX4 in the treatment of unresectable advanced hepatocellular carcinoma: a prospective cohort study*

Wang

Zhang

Peng

et al. 2020

Oncology and Translational Medicine

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Alcohol

2016

Reactions Weekly

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Marked rebound thrombocytosis in response to glucocorticoids in a patient with acquired amegakaryocytic thrombocytopenia

Nishino¹,

Kodaka²,

Sawada³

et al. 2018

JCEH

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Acquired amegakaryocytic thrombocytopenia (AATP) is a rare disease characterized by thrombocytopenia and the disappearance of marrow megakaryocytes. A 43-year-old man was admitted because of thrombocytopenia of 1.0×10 9 /L. Bone marrow aspirate demonstrated normal hematopoiesis lacking megakaryocytes, and AATP was diagnosed. The serum concentration of thrombopoietin (TPO) was high (7.72 fmol/mL). Prednisolone (PSL) at 60 mg/day was started and the platelet count recovered to 1,335×10 9 /L; however, excessive megakaryocytopoiesis and subsequent decline in platelet count were noted 14 days later. At the peak platelet count, the TPO remained at 3.79 fmol/mL and returned to a normal level of 0.40 fmol/mL during the period of normal platelet count after PSL tapering. The marked thrombocytosis in response to prednisolone may have been caused by the high TPO after the resolution of suppressed megakaryopoiesis. Marked rebound thrombocytosis beyond 1,000×10 9 /L after successful PSL treatment for AATP has not been previously reported.

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Acquired amegakaryocytic thrombocytopenic purpura induced by percutaneous ethanol injection during treatment of hepatocellular carcinoma: A case report

Cited by 3 publications

References 19 publications

Combination of TACE and FOLFOX4 in the treatment of unresectable advanced hepatocellular carcinoma: a prospective cohort study*

Combination of TACE and FOLFOX4 in the treatment of unresectable advanced hepatocellular carcinoma: a prospective cohort study*

Alcohol

Marked rebound thrombocytosis in response to glucocorticoids in a patient with acquired amegakaryocytic thrombocytopenia

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