CT-058 Outcome of Chemotherapy in G6PD-Deficient Patients

Abstract

G6PD deficiency is an inherited condition characterized by a lack of glucose-6-phosphate dehydrogenase, leading to hemolytic anemia after any oxidative stress. Many therapeutic agents have been implicated in hemolysis in G6PD-deficient patients, but little is known about the prevalence of G6PD deficiency in cancer patients. Data regarding the use and safety of chemotherapy in this population is extremely rare. We report the case of a 20-year-old male patient known to have G6PD deficiency who was diagnosed with a stage I non-seminomatous germ cell tumor (NSGCT). He underwent a left orchiectomy, revealing the presence of NSGCT with embryonal carcinoma predominance and lymphovascular invasion. Postoperative tumor markers (lactate dehydrogenase [LDH], αFP, βHCG) and a chest-abdomen-pelvis CT scan were within normal limits. Thus, he was a candidate to receive one cycle of BEP protocol (bleomycin, etoposide, and cisplatin). An extensive review of the literature regarding the premedications (aprepitant, palonosetron, metoclopramide, omeprazole, desloratadine, dexamethasone) and chemotherapeutic agents did not reveal any associated or reported hemolysis in patients with G6PD deficiency. A baseline hemolytic panel was tested, and hemoglobin, LDH, haptoglobin, bilirubin, and the reticulocyte count fell within normal limits. The patient received one cycle of BEP with serial hemolytic panel testing during the treatment administration, which did not reveal any induced hemolysis. He is currently in complete remission of his disease. Excluding case reports of rasburicase and one case of anthracycline-induced hemolysis in G6PD-deficient patients, descriptions of chemotherapy uses and outcomes in this population are extremely limited in the literature. Clinicians must consider the potential benefit of treatment to decide on cytotoxic therapies in G6PD-deficient patients. As medical oncologists, we believe that more information is required to support the safety of chemotherapy in this population.