Aplastic Anemia as a Cause of Death in a Patient with Glioblastoma Multiforme Treated with Temozolomide

Abstract

Lethal complications following temozolomide are, per se, extremely rare, however, a total of four other cases of aplastic anemia have been reported in the literature so far.

Temozolomide-Related Hematologic Toxicity

“…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.…”

“…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.…”

Radiotherapy of splenomegaly

“…The spleen fills the left hemiabdomen and can extend into the pelvis. This occurs in more than a third of patients and is thought to be due to extramedullary hematopoesis [1,2,5,10,13,17,18,20,21].…”

Radiotherapy with and without temozolomide in elderly patients with glioblastoma

“…This difference vanished when patients with better KPS were compared. One may speculate in how far this effect is related to a higher risk of TMZ-mediated side effects; though rare, fatal complications are described [10] and elderly patients in general might have an increased toxicity following chemotherapy [11].…”