An Unusual Case of Aplastic Anemia Caused by Temozolomide

Çömez, Gazi; Sevinç, Alper; Sever, Özlem Nuray; Babacan, Taner; Sarı, İbrahim; Camcı, Celalettin

doi:10.1155/2010/975039

Cited by 10 publications

(12 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Aplastic anemia has also been described [ 10 ]. However, the myelosuppression induced by temozolomide is thought to be dose limiting and reversible after two weeks of discontinuing the drug [ 11 ]. Overall, temozolomide is regarded as a safe and well-tolerated drug with the most serious side effects occurring in less than 5% of patients [ 1 , 3 , 10 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some medications that are known to induce cytopenias include nonsteroidal anti-inflammatory drugs, sulfonamides, chloramphenicol, anti-thyroid drugs, furosemide, anti-convulsant drugs, corticosteroids, and allopurinol [ 3 , 13 ]. Destruction of hematopoietic precursors is thought to be immune-mediated, with drugs and other chemicals triggering an aberrant T-cell response targeting hematopoietic stem cells [ 11 , 14 ]. It is unclear whether this is driven by antigens or immunological disarray [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Temozolomide-induced Aplastic Anemia Treated with Eltrombopag and Granulocyte Colony Stimulating Factor: A Report of a Rare Complication

Newton¹,

Kalamaha²,

Fernandes³

2018

Cureus

View full text Add to dashboard Cite

Temozolomide is an alkylating agent used in the treatment for glioblastoma multiforme (GBM), the most frequent primary malignant brain tumor in adults. Temozolomide was approved in March 2005 for treatment of GBM, with the Stupp protocol (radiotherapy and concomitant use of temozolomide). Despite initial studies demonstrating mild and well-tolerated side effects, several recent reports describe severe hematologic adverse effects associated with temozolomide use. We report the case of a 51-year-old female diagnosed with GBM who received the standard treatment protocol of radiotherapy and concomitant temozolomide. The patient developed prolonged pancytopenia. Bone marrow biopsy demonstrated hypocellular bone marrow with diminished trilineage hematopoiesis, suggestive of drug-induced aplastic anemia. Although temozolomide is regarded as a safe drug with few side effects, severe hematologic toxicities have been reported.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Temozolomide-induced Aplastic Anemia Treated with Eltrombopag and Granulocyte Colony Stimulating Factor: A Report of a Rare Complication

Newton¹,

Kalamaha²,

Fernandes³

2018

Cureus

View full text Add to dashboard Cite

show abstract

“…We analyzed 21 cases of TMZ-related hematological IDRs, including one case of grade V myelosuppression, which we encountered at our center [5,6,[9][10][11][12][13][14][15][16][17][18][19][20][21] (Table 1). Information about sex was available for 16 cases; there were 12 female and four male patients.…”

Section: Hematological Idiosyncratic Drug Reactionsmentioning

confidence: 99%

Temozolomide-related idiosyncratic and other uncommon toxicities

Dixit

Baker²,

Walmsley³

et al. 2012

Anti-Cancer Drugs

View full text Add to dashboard Cite

Temozolomide (TMZ)-related idiosyncratic and other uncommon toxicities have been reported. To better characterize these toxicities and to identify any associated risk factors, we performed a systematic review. We searched the PubMed database, limited to the English language, published between 1999 and December 2011. We selected only those articles in which TMZ was temporally related and was the sole or main contributing chemotherapeutic drug to idiosyncratic drug reactions (IDRs) and other uncommon toxicities. Hematological IDRs are biopsy-proven aplastic anemia or grade V toxicity or grade IV toxicity with slow and incomplete hematological recovery. Seventy-three cases were identified, including 21 hematological IDRs, 31 nonhematological IDRs and uncommon infections, and 21 second primary cancers. With a caveat of publication and reporting bias, the following observations could be made. The hematological IDRs predominantly occurred in female patients (exact binomial two-tailed, P=0.0041) and most patients were receiving TMZ concomitantly with radiotherapy for glioma. The median duration of exposure to TMZ was 30 days and the median cumulative TMZ exposure was 2250 mg/m (range, 500-6900 mg/m). The sex predilection was not evident in nonhematological IDRs and other uncommon toxicities. TMZ-induced pneumonitis and cholestatic hepatitis are emerging as a nonhematological hypersensitive reaction and IDR, respectively. For TMZ-related myelodysplasia or leukemia, the cumulative dose of TMZ ranged from 1400 to 30 000 mg/m. The cumulative dose of TMZ was lower and latency was shorter with a previous exposure to other leukemogenic drugs, suggesting that TMZ may have augmented the leukemogenic potential of other drugs. Early appearance of profound myelosuppression during the course of TMZ and concurrent radiotherapy could be a hematological IDR, which warrants prompt investigations to exclude aplastic anemia. Myelodysplasia or leukemia developed after a median TMZ exposure of 15 g/m.

show abstract

“…Most of these cases occurred very early during TMZ administration: in 3 patients during concurrent TMZ [3,4,5]; in 1 patient before starting adjuvant treatment [6]; in 1 patient during the first cycle of adjuvant TMZ [7]. In 2 other reports [8,9], aplastic anemia occurred later in the course of TMZ administration after 3 and 4 cycles of adjuvant treatment, respectively. In 4 of these patients, there may have been a confounding effect due to concurrent medication with antibiotics and/or anticonvulsant drugs, which are known to be potentially associated with aplastic anemia.…”

Section: Resultsmentioning

confidence: 99%

“…The most common side effects are mild to moderate, and are represented by fatigue, nausea, vomiting, thrombocytopenia, and neutropenia. However severe hematologic adverse events (HAEs), including myelodysplastic syndrome (MDS) and aplastic anemia, have been recently reported in several case reports and small series [3,4,5,6,7,8,9,10,11,12,13,14,15]. Therefore we conducted a literature search in order to evaluate the incidence of TMZ-related hematologic toxicity and its potential impact on daily clinical practice when treating GBM patients.…”

Section: Introductionmentioning

confidence: 99%

Temozolomide-Related Hematologic Toxicity

Scaringi¹,

Sanctis²,

Minniti³

et al. 2013

Oncol Res Treat

View full text Add to dashboard Cite

Temozolomide (TMZ) is an oral alkylating agent used for the treatment of recurrent or newly diagnosed malignant gliomas with significant survival benefit. TMZ is generally well tolerated and safe. The most common side effects are mild to moderate, and are represented by fatigue, nausea, vomiting, thrombocytopenia, and neutropenia. However severe hematologic adverse events (HAEs), including myelodysplastic syndrome and aplastic anemia, have also been reported. In this review we present an overview of the available literature of HAEs after exposure to TMZ.

show abstract

An Unusual Case of Aplastic Anemia Caused by Temozolomide

Cited by 10 publications

References 7 publications

Temozolomide-induced Aplastic Anemia Treated with Eltrombopag and Granulocyte Colony Stimulating Factor: A Report of a Rare Complication

Temozolomide-induced Aplastic Anemia Treated with Eltrombopag and Granulocyte Colony Stimulating Factor: A Report of a Rare Complication

Temozolomide-related idiosyncratic and other uncommon toxicities

Temozolomide-Related Hematologic Toxicity

Contact Info

Product

Resources

About