Leucopenia induced by tamoxifen in a breast cancer patient: a case report

Abstract

Background:The main side effects of Tamoxifen are menopausal symptoms. We report a case of leucopenia induced by Tamoxifen in a 28-year-old woman treated in the adjuvant setting. Case Presentation: A 28-year-old woman was diagnosed with invasive ductal carcinoma of the left breast. The final tumor stage was T2, N3, M0, Stage IIIc. She received adjuvant chemotherapy with four cycles of Adriamycin and Cyclophosphamide every three weeks, followed by four cycles of Taxol every three weeks. After chemotherapy, she received the standard dose of adjuvant radiotherapy (50 Gy/15 fractions) for three weeks. Then she received tamoxifen and goserelin treatment for two years. Zoladex was discontinued, and she received tamoxifen only for five months. Blood examination during tamoxifen treatment demonstrated the patient had anemia (hemoglobin: 9.5 g/dL), leucopenia (white blood cells (WBC): 2.2×10 9 /L), neutropenia (granulocytes: 0.9×10 9 /L) and no thrombocytopenia (platelets: 222×10 9 /L). Antinuclear antibodies (ANA) test, anti-double stranded DNA antibody test, erythrocyte sedimentation rate, or C -Reactive Protein (CRP) didn't suggest connective tissue disorder. Moreover, bone marrow aspirate and biopsy of bilateral iliac crest didn't reveal abnormal findings. Tamoxifen was discontinued for one month, and we found improvement of leucopenia (WBC: 3.24×10 9 /L). However, leucopenia recurred to the severer degree after resume of tamoxifen treatment (WBC: 2.6×10 9 /L). These findings suggested that tamoxifen was responsible for leucopenia in this patient. Conclusion: Leucopenia is a rare and important adverse event of tamoxifen, which can cause treatment interruption.