Abstract
BackgroundOxaliplatin is a platinum compound used in the treatment of gastrointestinal malignancies, including colorectal cancer. The incidence of hypersensitivity reaction in patients receiving oxaliplatin is approximately 15%, with severe reaction (grade 3 and 4) occurring in 2% of patients.Case presentationWe report two patients with metastatic colorectal cancer who developed de novo hypersensitivity reaction and acute thrombocytopenia after oxaliplatin infusion. Both patients had oxaliplatin treatment several years before and exhibited hypersensitivity on the third dose of oxaliplatin in recent treatment. Oxaliplatin was discontinued when clinical reaction was identified. Both patients were confirmed to have strong oxaliplatin-induced IgG platelet-reactive antibodies. Both patients' thrombocytopenia resolved within two weeks after discontinuation of oxaliplatin. One patient had disease stabilization lasting for three months without chemotherapy. Both patients subsequently received other chemotherapeutic agents without evidence of hypersensitivity reaction or immune-mediated thrombocytopenia.ConclusionWe recommend vigilant monitoring of complete blood count and signs and symptoms of bleeding after the occurrence of oxaliplatin-induced hypersensitivity to avoid serious complications of immune-mediated thrombocytopenia.
Highlights
Oxaliplatin is a platinum compound used in the treatment of gastrointestinal malignancies, including colorectal cancer
We describe two cases of immune-mediated thrombocytopenia immediately following the onset of the hypersensitivity reaction in patients with metastatic colorectal cancer (CRC) receiving oxaliplatin treatment
This is the first report demonstrating the association between de novo oxaliplatin-induced hypersensitivity reaction and immune-mediated thrombocytopenia from oxaliplatin
Summary
Oxaliplatin is a platinum compound used in the treatment of gastrointestinal malignancies, including colorectal cancer. We describe two cases of acute thrombocytopenia with concurrent oxaliplatin-induced hypersensitivity reaction in patients with metastatic CRC. Both patients had prior oxaliplatin treatment without occurrence of hypersensitivity, or acute thrombocytopenia and received oxaliplatin several years later due to disease progression with non-responsiveness to other chemotherapeutic regimens. Oxaliplatin treatment was not resumed because of hypersensitivity reaction with concomitant mild thrombocytopenia; a presentation similar to patient 1.
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