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Meng W, Hua J, Wang J. Successful avatrombopag combined with cyclosporine treatment for carboplatin/pegylated liposomal doxorubicin/bevacizumab-induced acquired amegakaryocytic thrombocytopenia in a patient with recurrent ovarian cancer: case report. Front Oncol 2024; 14:1253230. [PMID: 38406810 PMCID: PMC10884148 DOI: 10.3389/fonc.2024.1253230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Carboplatin/pegylated liposomal doxorubicin/bevacizumab is an accepted standard anti-cancer treatment option for recurrent ovarian cancer. However, the occurrence of adverse events associated with this therapeutic regimen limits its continued clinical use. Among these adverse events, acquired amegakaryocytic thrombocytopenia is a rare but often potentially life-threatening adverse effect, and is intolerant to multiple treatment approaches. We report, for the first time, the successful treatment using avatrombopag combined with cyclosporine in one case of carboplatin/pegylated liposomal doxorubicin/bevacizumab-induced acquired amegakaryocytic thrombocytopenia, which was refractory or intolerant to glucocorticoids, intravenous immunoglobulin, recombinant human thrombopoietin, androgen, and even thrombopoietin receptor receptor agonist eltrombopag and herombopag. To date, this case manifests as normal platelet counts that are independent of transfusion. Our findings suggest that this combination is a potential and valuable alternative in acquired amegakaryocytic thrombocytopenia.
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Affiliation(s)
- Weikang Meng
- Department of Hematologic Oncology, Taizhou Municipal Hospital, Taizhou, China
| | - Jinsheng Hua
- Department of Hematologic Oncology, Taizhou Municipal Hospital, Taizhou, China
| | - Jiabing Wang
- Department of Pharmacy, Taizhou Municipal Hospital, Taizhou, China
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2
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Ikeda N, Hisano Y, Kamao T, Uno M, Mizushima T. Acquired Amegakaryocytic Thrombocytopenia Associated With Autoimmune Hemolytic Anemia. Cureus 2022; 14:e27315. [PMID: 36042987 PMCID: PMC9411021 DOI: 10.7759/cureus.27315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/05/2022] Open
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Iyama S, Takada K, Yoshida M, Takahashi D, Kobune M. Acquired amegakaryocytic thrombocytopenic purpura possibly induced by anti-PD-1 antibody. Ann Hematol 2020; 99:1669-1670. [PMID: 32367179 DOI: 10.1007/s00277-020-04053-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Satoshi Iyama
- Department of Hematology, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - K Takada
- Department of Hematology, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.,Department of Medical Oncology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - M Yoshida
- Department of Medical Oncology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - D Takahashi
- Research and Development Department, Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - M Kobune
- Department of Hematology, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
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4
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Son B, Park HS, Han HS, Kim HK, Baek SW, Yang Y, Lee KH, Kwon J. A Case of Acquired Amegakaryocytic Thrombocytopenia with Anti-c-mpl Autoantibody: Comparison with Idiopathic Thrombocytopenic Purpura. Acta Haematol 2019; 142:239-243. [PMID: 31132762 DOI: 10.1159/000499523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 03/12/2019] [Indexed: 11/19/2022]
Abstract
Acquired amegakaryocytic thrombocytopenia (AAMT) is a rare disease that causes severe bleeding. The pathogenesis and treatment of AAMT have not yet been defined. We report the case of a 60-year-old woman diagnosed with AAMT, who presented with severe thrombocytopenia, gastroin-testinal bleeding, and significantly reduced bone marrow megakaryocytes. The patient was treated with methylprednisolone, cyclosporin, and intravenous immunoglobulin. After 2 weeks of treatment, her platelet count started to increase, and her bone marrow megakaryocyte count had normalized 3 months after diagnosis. At the time of diagnosis, the patient was seropositive for anti-c-mpl antibody but was seen to be seronegative once the platelet count recovered. In contrast, anti-c-mpl antibodies were not detected in the serum of 3 patients with idiopathic thrombocytopenic purpura. This case study suggests that anti-c-mpl antibody plays an important role in the development of AAMT, and that intensive immunosuppressive treatment is required for autoantibody clearance and recovery of megakaryocyte count.
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Affiliation(s)
- Bora Son
- Department of Laboratory Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Laboratory Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Hee Sue Park
- Department of Laboratory Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Laboratory Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Seung Woo Baek
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Yaewon Yang
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Ki Hyeong Lee
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jihyun Kwon
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea,
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea,
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Nishino S, Kodaka T, Sawada Y, Goka T, Gotoh Y, Tsunemine H, Takahashi T. Marked rebound thrombocytosis in response to glucocorticoids in a patient with acquired amegakaryocytic thrombocytopenia. J Clin Exp Hematop 2018; 58:166-170. [PMID: 30416171 PMCID: PMC6407476 DOI: 10.3960/jslrt.18016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
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 1.0×109/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 1,335×109/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 1,000×109/L after successful PSL treatment for AATP has
not been previously reported.
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Novotný JP, Köhler B, Max R, Egerer G. Acquired Amegakaryocytic Thrombocytopenic Purpura Progressing into Aplastic Anemia. Prague Med Rep 2018; 118:147-155. [PMID: 29324222 DOI: 10.14712/23362936.2017.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Acquired amegakaryocytic thrombocytopenic purpura (AATP) is a rare hematological disorder characterized by severe thrombocytopenia and a complete or near-to complete absence of megakaryocytes in the bone marrow, while granulopoiesis, as well as erythropoiesis are usually preserved. Although autoimmune mechanisms are believed to be causative, the exact underlying pathogenesis is not known. To date, only few cases have been reported and management of this disease remains controversial with immunosuppression being the treatment modality of choice in the majority of patients. In this article, we report a case of newly acquired AATP without an associated autoimmune disease, refractory to corticoids, intravenous immunoglobulin (IVIG) and second-generation TPO (thrombopoietin) agonists, which have recently been approved for the treatment of thrombocytopenia. Finally, in accordance with other reports, disease progression into aplastic anemia has occurred.
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Affiliation(s)
| | - Birgit Köhler
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Regina Max
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Gerlinde Egerer
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
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Chen ZR, Ma Y, Guo HH, Lu ZD, Jin QH. Therapeutic efficacy of cyclosporin A against spinal cord injury in rats with hyperglycemia. Mol Med Rep 2018; 17:4369-4375. [PMID: 29328412 PMCID: PMC5802210 DOI: 10.3892/mmr.2018.8422] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/24/2017] [Indexed: 01/20/2023] Open
Abstract
The present study aimed to explore the therapeutic effects of cyclosporin A (CsA) on spinal cord injury (SCI) in rats with hyperglycemia and to identify a novel potential method to treat SCI in the presence of hyperglycemia. Female Sprague‑Dawley (SD) rats were randomly allocated into four groups: Sham, SCI, SCI+hyperglycemia and SCI+hyperglycemia+CsA groups. Streptozotocin‑induced hyperglycemic SD rats and a weight‑drop contusion SCI model were established. The Basso, Beattie, Bresnahan scale and inclined plane test were used to evaluate the neurological function of the rats. Flow cytometric assay was performed to detect the apoptotic rates of cells in the spinal cord. ELISA and western blot analysis were performed to determine the levels of interleukin (IL)‑10, tumor necrosis factor (TNF)‑α, cyclophilin‑D (Cyp‑D) and apoptosis‑inducing factor (AIF). The results demonstrated that CsA significantly improved the neurological function of the SCI rats with hyperglycemia. CsA markedly reduced the number of apoptotic cells exaggerated by hyperglycemia in the spinal cord of the SCI rats. CsA significantly decreased the expression levels of IL‑10, TNF‑α, Cyp‑D and AIF in the spinal cord of the SCI rats. Overall, the present study revealed a significant role of CsA in the treatment of SCI in the presence of hyperglycemia by inhibiting the apoptosis of spinal cord cells.
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Affiliation(s)
- Zhi-Rong Chen
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Yi Ma
- Department of Pathology and Physiology, Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Hao-Hui Guo
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Zhi-Dong Lu
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Qun-Hua Jin
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
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