Oxaliplatin-induced immune mediated thrombocytopenia

Abstract

Oxaliplatin is a third generation platinum compound used in patients with advanced colorectal carcinoma. Recently, the mechanism of a rare drug-induced immune thrombocytopenia in patients receiving oxaliplatin has been described. This complication is caused by oxaliplatin-dependent antibodies directed against platelet surface glycoproteins, and is unrelated to myelosuppression. In this report, we describe two patients who developed thrombocytopenia immediately soon after receiving oxaliplatin. Sensitization presumably had occurred after receiving oxaliplatin during preceding courses of multiagent chemotherapy that included oxaliplatin.

Oxaliplatin-induced Acute Thrombocytopenia: A Case Report and Review of the Literature

“…The frequency of oxaliplatin-induced acute thrombocytopenia is unknown; however, the occurrence rate is probably underestimated because complete blood counts are not routinely performed in patients without severe allergic symptoms or bleeding tendencies. The characteristics of patients diagnosed with oxaliplatin-induced acute thrombocytopenia, including our patient, are summarized in Table. Similar to our case, previous reports (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) have shown that the onset of oxaliplatininduced acute thrombocytopenia is relatively rapid and most affected patients are women (75%) with an average age of 59.8 years (range: 38-83 years). The average number of cycles of onset of thrombocytopenia is 17.3 (range: 9-24 cycles), and all but one case (96%) occurred after 10 cycles of chemotherapy, which suggests that female sex and prolonged exposure to oxaliplatin are risk factors for the development of this reaction.…”

“…Because oxaliplatin-induced acute thrombocytopenia occurs abruptly and is sometimes life-threatening, appropriate therapy should be provided. To the best of our knowledge, 23 cases of oxaliplatin-induced acute thrombocytopenia have been reported (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). The frequency of oxaliplatin-induced acute thrombocytopenia is unknown; however, the occurrence rate is probably underestimated because complete blood counts are not routinely performed in patients without severe allergic symptoms or bleeding tendencies.…”

“…The average number of cycles of onset of thrombocytopenia is 17.3 (range: 9-24 cycles), and all but one case (96%) occurred after 10 cycles of chemotherapy, which suggests that female sex and prolonged exposure to oxaliplatin are risk factors for the development of this reaction. The average platelet count at onset is 17,000 / μL, and various symptoms such as chills (6, 7, 12, 18), fever (7), skin rashes (6, 18), abdominal or back pain (5,9,11,12), nausea (13,21), dizziness (21), mental status changes (13) and bronchospasm (18) are experienced, with the exception of bleeding tendencies. Because oxaliplatin-induced acute thrombocytopenia does not always accompany a bleeding tendency at the time of initial presentation, physicians need to pay careful attention and initiate blood testing for thrombocytopenia to manage patients with unexplained symptoms who receive oxaliplatin.…”

Oxaliplatin-Induced Neuropathy: Oxidative Stress as Pathological Mechanism. Protective Effect of Silibinin

“…51 Moreover, dynamin-related protein 1, a protein that catalyzes the process of mitochondrial fission with the consequent ROS production, is involved in chemotherapy-induced neuropathy in rats. 16 By contrast, a low relevance of ROS production from inflammatory cells could be hypothesized since another side effect related to prolonged oxaliplatin use is a nonmyelosuppressive hematologic toxicity, which includes hemolysis, 18 thrombocytopenia, 5 and pancytopenia. 48 It is of fundamental importance that, to be clinically useful, the antineuropathic agents must reduce the neurotoxic effect of the chemotherapeutic agent maintaining its full anti-tumor efficacy.…”

Oxaliplatin induced disseminated intravascular coagulation: A case report and review of literature

“…There are multiple case reports of ITP and Evans syndrome related to Oxaliplatin infusion [6][7][8][9][10][11][12] . Very rarely Oxaliplatin has been reported to cause life threatening acute hematological toxicities with decrease of platelet counts [13] , in some cases associated with hemolysis and occasionally with neutropenia [12] .…”