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Erschienen in: Investigational New Drugs 5/2017

30.03.2017 | SHORT REPORT

Aplastic anemia in a lung adenocarcinoma patient receiving pemetrexed

verfasst von: Goushi Matama, Takaaki Tokito, Hiroaki Takeoka, Yuki Hiraoka, Norikazu Matsuo, Masayuki Nakamura, Hidenobu Ishii, Takashi Kinoshita, Koichi Azuma, Kazuhiko Yamada, Tomoaki Hoshino

Erschienen in: Investigational New Drugs | Ausgabe 5/2017

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Summary

Pemetrexed (PEM) is an antimetabolite drug that interferes with enzymes involved in DNA synthesis and also the folate-dependent metabolic processes necessary for DNA replication and homocysteine homeostasis. Continuation maintenance with PEM after induction therapy with PEM plus cisplatin has been the standard form of first-line chemotherapy for advanced non-squamous non-small cell lung cancer. The regimen has a low incidence of bone marrow suppression, and the incidences of anemia, leukopenia, neutropenia and thrombocytopenia exceeding grade 3 are less than 5%. Here we report a 68-year-old Japanese man with stage IIIB (cT4N3M0) lung adenocarcinoma who received 4 cycles of chemotherapy with PEM 500 mg/m2 and cisplatin 75 mg/m2 every three weeks, which resulted in a partial response, and then continued to receive maintenance PEM monotherapy. After 11 cycles of PEM maintenance therapy, the patient’s platelet count decreased, and progressed to pancytopenia within two months. A bone marrow puncture revealed replacement with fatty marrow. As other diseases possibly responsible for pancytopenia were ruled out, we diagnosed the patient as having aplastic anemia. This is the first reported case of aplastic anemia to have occurred during PEM therapy. Clinicians should bear in mind that PEM can potentially trigger severe pancytopenia, including aplastic anemia.
Literatur
1.
Zurück zum Zitat Paz-Ares L, de Marinis F, Dediu M, Thomas M, Pujol J-L, Bidoli P et al (2012) Maintenance therapy with PEM plus best supportive care versus placebo plus best supportive care after induction therapy with PEM plus cisplatin for advanced non-squamous non-small-cell lung cancer (PARAMOUNT): a double-blind, phase 3, randomised controlled trial. Lancet Oncol 13:247–255CrossRef Paz-Ares L, de Marinis F, Dediu M, Thomas M, Pujol J-L, Bidoli P et al (2012) Maintenance therapy with PEM plus best supportive care versus placebo plus best supportive care after induction therapy with PEM plus cisplatin for advanced non-squamous non-small-cell lung cancer (PARAMOUNT): a double-blind, phase 3, randomised controlled trial. Lancet Oncol 13:247–255CrossRef
2.
Zurück zum Zitat Issaragrisil S, Kaufman DW, Anderson T, Chansung K, Thamprasit T, Sirijirachai J et al (1997) Low drug attributability of aplastic anemia in Thailand. Blood 89:4034–4039PubMed Issaragrisil S, Kaufman DW, Anderson T, Chansung K, Thamprasit T, Sirijirachai J et al (1997) Low drug attributability of aplastic anemia in Thailand. Blood 89:4034–4039PubMed
3.
Zurück zum Zitat Bacigalupo A, Oneto R, Bruno B, Socié G, Passweg J, Locasciulli A et al (2000) Current results of bone marrow transplantation in patients with acquired severe aplastic anemia: report of the European Group for Blood and Marrow transplantation. Acta Haematol 103:19–25CrossRef Bacigalupo A, Oneto R, Bruno B, Socié G, Passweg J, Locasciulli A et al (2000) Current results of bone marrow transplantation in patients with acquired severe aplastic anemia: report of the European Group for Blood and Marrow transplantation. Acta Haematol 103:19–25CrossRef
4.
Zurück zum Zitat Lim AYN, Gaffney K, Scott DGI (2005) Methotrexate-induced pancytopenia: serious and under-reported? Our experience of 25 cases in 5 years. Rheumatology 44:1051–1055CrossRef Lim AYN, Gaffney K, Scott DGI (2005) Methotrexate-induced pancytopenia: serious and under-reported? Our experience of 25 cases in 5 years. Rheumatology 44:1051–1055CrossRef
5.
Zurück zum Zitat Fernando GI, Sahar EM, Shiri S, Hazem A, Amer KS, Simon B, et al. (2014) Methotrexate-induced pancytopenia. Case Reports in Rheumatology 2014: 679580. Fernando GI, Sahar EM, Shiri S, Hazem A, Amer KS, Simon B, et al. (2014) Methotrexate-induced pancytopenia. Case Reports in Rheumatology 2014: 679580.
6.
Zurück zum Zitat Kremer J, Galivan J, Streckfuss A, Kamen B (1986) Methotrexate metabolism analysis in blood and liver of rheumatoid arthritis patients. Association with hepatic folate deficiency and formation of polyglutamates. Arthritis Rheum 29:832–835CrossRef Kremer J, Galivan J, Streckfuss A, Kamen B (1986) Methotrexate metabolism analysis in blood and liver of rheumatoid arthritis patients. Association with hepatic folate deficiency and formation of polyglutamates. Arthritis Rheum 29:832–835CrossRef
7.
Zurück zum Zitat Koizumi S, Curt GA, Fine RL, Griffin JD, Chabner BA (1985) Formation of methotrexate polyglutamates in purified myeloid precursors cells from normal human bone marrow. J Clin Invest 75:1008–1014CrossRef Koizumi S, Curt GA, Fine RL, Griffin JD, Chabner BA (1985) Formation of methotrexate polyglutamates in purified myeloid precursors cells from normal human bone marrow. J Clin Invest 75:1008–1014CrossRef
8.
Zurück zum Zitat Rosenblatt DS, Whitehead VM, Dupont MM, Vuchich MJ, Vera N (1978) Synthesis of methotrexate polyglutamates in cultured human cells. Mol Pharmacol 14:210–214PubMed Rosenblatt DS, Whitehead VM, Dupont MM, Vuchich MJ, Vera N (1978) Synthesis of methotrexate polyglutamates in cultured human cells. Mol Pharmacol 14:210–214PubMed
9.
Zurück zum Zitat Robert A Brodsky, Richard J Jones (2005) Aplastic anaemia. Lancet 365: 1647–1656. Robert A Brodsky, Richard J Jones (2005) Aplastic anaemia. Lancet 365: 1647–1656.
10.
Zurück zum Zitat Parmaceuticals and Medical Devices Agency (2008) Parmaceuticals and Medical Devices Agency (2008)
Metadaten
Titel
Aplastic anemia in a lung adenocarcinoma patient receiving pemetrexed
verfasst von
Goushi Matama
Takaaki Tokito
Hiroaki Takeoka
Yuki Hiraoka
Norikazu Matsuo
Masayuki Nakamura
Hidenobu Ishii
Takashi Kinoshita
Koichi Azuma
Kazuhiko Yamada
Tomoaki Hoshino
Publikationsdatum
30.03.2017
Verlag
Springer US
Erschienen in
Investigational New Drugs / Ausgabe 5/2017
Print ISSN: 0167-6997
Elektronische ISSN: 1573-0646
DOI
https://doi.org/10.1007/s10637-017-0462-z

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